snafu’s AchillesBlog

Please please can someone give me some advice ASAP?

I have a urinary tract infection, and I’ve just been prescribed nitrofurantoin. I am keen to take them and get the infection under control (I have seen what happens when I don’t, and it’s not nice). But I just can’t bring myself to take them until I’ve checked that they are safe. Will they cause another rupture? I am 5 months since my rupture, and so happy to be more or less back to normal, that I so don’t want to start again! I took nitrofurantoin 6 months ago for the same problem, and I worry about whether the antibiotics caused the rupture. I think this is not the troublesome type of antibiotic, but I can’t be sure. I have googled, and it looks like this one isn’t associated with ATR, but I just can’t take them until someone here has told me it will be okay. Can anyone help?!

I went back to fracture clinic two days ago - at 11 weeks post injury. The doctor I saw asked what had happened so far (no-one seems to have notes on this! Or maybe it’s just more efficient to ask me - I don’t know). Anyway I explained - non-op, 5 weeks NWB in casts at two different angles, then 6 weeks basically FWB in the boot (2 weeks with 2 wedges, 2 weeks with 1 wedge, and 2 weeks with no wedges).

She did the Thompson test and sounded happy, and so now she has ‘discharged me to physio’! I left the boot and crutches behind in her office and walked out of there with just the gel insert in my shoe. At first I was slow and hobbling, but I have improved quickly over the last couple of days. Now I still have a bit of a limp, but not very bad.

I joined the gym yesterday so that I could do other exercise while I wait to be able to run again. So today I went for my first swim - yay! My first physio appointment is on Monday (NHS). So as far as I can tell, I am kind of healed. I can walk, for example! I cannot stand on tiptoe on the injured foot, but I am super-happy!

I have a couple of questions in case any of you kind people have the answers:

1. Besides swimming, I am also allowed now to use the exercise bike. I haven’t really ever used one before. Is there anything in particular I should bear in mind, or just sit on it and pedal for a bit!?

2. When can I know that I won’t rerupture, and start pushing myself?

I went to the fracture clinic again today. I was excited because last time I was there (4 weeks ago), I was told that after these 4 weeks in a boot I could move to shoes and start physiotherapy.

When I first got in, I was seen by one doctor who did the Thompson test, which I definitely failed (I think I have that the right way around - anyway it was a very clear *good* result). She felt carefully all along the tendon. Basically all seemed good. She talked about starting swimming now, and when I asked if I was going into shoes she went off to ask the surgeon (or consultant or something). When she came back, the result was different - stay in the boot (day and night) for another 3 weeks! And obviously no swimming.

I accepted this, but after I left the room I started to feel really infuriated. All these doctors have different protocols, and you get a different one each time. They all just start trying to apply their protocol to your situation, and the end result always seems to be that you have to take things slower. So I went back and asked again. The doctor explained that this particular consultant liked people to be casted/booted for 10 weeks, on some 4-3-3 programme. I pointed out that I was casted for 5 weeks, and have now been in the boot for just over 4 weeks - so I am already over 9 weeks - why do I have to wait 3 more weeks before going into shoes?

We reached a sort of compromise, whereby I spend 1 more week in the boot at all times (day and night), and then after one week I carry on with the boot outside, but at home I take off the boot and try walking with shoes with some inserts that they gave me. Then they will see me again in 2 weeks because they ‘need to keep an eye on me’. I am hoping that physiotherapy will start then…

I think the thing that is most annoying is that I am still wearing the boot at night. Can this really be necessary?

I’m not even sure this is wholly about the achilles injury, but I think that is playing its part.

My healing seems to be going well (as far as I can tell). I was so overjoyed to be able to walk around the house crutch free (since being in the boot) - I was actually grinning while I walked for the first day!

But now today I don’t feel so lucky. Sure, I can do the stuff that I have to do (get the kids’ tea on the table, keep vaguely on top of the house), and I haven’t taken any sick leave from work (mainly through working at home - though I can also commute in when I need to). But I am tired by the end of the day, and can’t seem to have fun evenings. What did I used to do? I think partly I was happy-tired in the evenings from sport, and partly on a high from a good (interactive! At work! Seeing colleagues!) day’s work. Plus I think I did more fun stuff with the kids, which made me feel happier/more fulfilled by the end of the day.

Now I seem to watch more TV with them (very tired after getting in). And I am working from home, so seem more dependent on my husband for evening company. He comes home quite late anyway. And then I feel tired and grumpy, and he doesn’t seem to want to slow down to my pace (understandably). I think this has come to a head because he is going to the opera with some friends from work. I’ve never known him be into opera, but I guess it’s a different thing to do. They are booking ’standing room only’ tickets, so obviously I can’t come - even if I had childcare, and even if I was invited which I don’t think I am. I just feel like I can’t join in with any fun, and I’m not sure I ever will be able to again. I just feel so tearful about it!

Sorry for all this emotional outpouring - I just felt the need to write it all down. Is anyone else too tired to do the stuff they used to do?

Last night I took the boot off to wash the leg. This was the first time I had seen it/touched it for a while, so I was a bit scared as to what it would be like. I was very relieved! It looks basically normal (though hairy). It is a bit wasted, but my calf is smallish anyway so it wasn’t such a shock. The foot was very slightly swollen, though this swelling seemed to disappear after the foot had been aired a bit. The main thing that was different was (surprise surprise) the achilles tendon! It kind of felt and looked like a normal tendon - and I was so relieved to feel that I could feel and see the tendon there and it wasn’t ’squishy’ there at the back! But there is a hardish lump there just above the bit of tendon that you can feel in your ankle. I’m guessing this is where the healing is happening.

I gently washed and moisturised, and had a little go at moving… I can do things like move my foot up and down and side to side a bit. But I am scared to touch it or move it too much. It’s not that it hurts, I think it’s just that I am scared and instinctively treating it like it is tender. How much/what should I do? My NHS physio doesn’t start until 4 weeks time (which will be 9 weeks since the rupture). Should I find a private physio? Or are there any gentle and safe exercises that I should be doing at home? Or is the main thing just to try to walk on it!?

I went to the hospital today (5 weeks since the rupture, and I have not had the operation). I have been in casts until now, and was excited about getting the boot!

In fact, when my cast came off, I felt vulnerable, and not at all ready to walk. I was fitted with a grey aircast boot, with 2 inflatable things in it. I have to wear this for 4 weeks, day and night. It currently has 2 wedges in, and I have to take one out in 2 weeks time. So in 4 weeks, I go back to the hospital - I think to move into 2 shoes and start physio.

I have been told that I can put as much weight as I like on the booted foot, and walk as far as I like. I had visions of myself immediately walking out of there crutch free, but in fact I just crutched my way out of there more or less like I went in! I am putting some weight on the foot though, and standing has become more comfortable, so I guess that I am putting weight on that foot then. I am trying to walk on it heel to toe as recommended on here, and using both crutches to make this possible.

What happens from here? Do I just keep practising, and after a while somehow it gets easier, and I let go of the crutches?

First of all I just want to say how great it is to be doing this blog, and know there are people I can talk to about this/ask questions. Anyway, here’s my latest dilemma.

I did the rupture 5 weeks ago, and I’ve been in 3 casts - first two with pointy toes, current one less pointy. I’m pretty sure that when I go back to hospital in 3 days time, I will get … THE BOOT. (I don’t know what sort of boot or anything). so I am thinking (hoping) that I will be walking around in this boot in the day time, inside and out. So it will get a bit muddy, right? (In the UK in autumn it usually rains quite a lot). But I’m also guessing that I will be told to sleep in the boot. Won’t the boot be too muddy to sleep in, besides being big and hard?

Obviously I’ve been sleeping in my fibreglass cast (can’t exactly take it off) and I find that fine to sleep in. But it’s not that bulky, not exactly hard, and not muddy (because I am officially NWB). Should I buy some sort of night splint to sleep in? I’m thinking if I buy it now I can take it to my appointment and get it set at the right angle or whatever? If so, what should it be like - what does it need to do? Or should I soon be sleeping with a bare leg? Or should I just suck it up and sleep in the boot?

When I ruptured my achilles, I googled (of course) and discovered that this usually happened to ‘weekend warriors’. I found this depressing - is that what I was? Should I stop flinging myself around at the weekends and walk along sedately?

But thinking about this more, I’ve got a theory. To get a tendon rupture you need to have some sort of tendon degeneration gene or whatever. Not everyone has one - maybe it’s a fairly low percentage of the population. And then the rupture happens if:

1) you are older (say than 30) - though I know sometimes they can happen to younger people too, I think all else being equal they get more likely as you get older.

2) you do a lot of sport (of particular kinds). And (here’s the controversial bit!) I think the more sport you do, the more likely you are to rupture.

Now statistically, of all the sporty people who are older than 30, only a very small proportion will be professional atheletes. So all the other ones have jobs - and so inevitably they will do most of their sport at the weekend. That totally accounts for why achilles tendons are usually seen in ‘weekend warriors’. It’s not because you are more likely to get one if you are a weekend warrior than if you are a professional athelete - it’s just that there are an awful lot more sporty people who are not professional (aka weekend warriors) than professional atheletes.

So what I take from all this (if it’s right) is that there should be no stigma attached to an ATR. It doesn’t show that you were trying to do too much, without being fit enough. The image ‘weekend warrior’ conjures up - of someone unfit who suddenly decides to show the kids how it’s done - is the wrong image. Lots of people on these boards sound really properly fit. And I (though no superwoman) have been running regularly pretty faithfully for nearly 20 years, and doing pilates and weight bearing besides. I am light, I can do (correction: could do) handstands… surely I didn’t get this ATR because I just wasn’t fit enough?

I just read some scary stuff about how likely I am to rerupture, or rupture the other achilles, and now I’m scared!

Can anyone clarify a couple of things?

1) How likely is it that I will rupture the other achilles over the course of my lifetime (I’m 39 now)?

2) Would I reduce the chance of rupturing the other achilles if I changed my lifestyle - maybe switched from running to swimming, for example? I don’t want to do this, but I might if it was definitely definitely the sensible thing to do.

3) As for my current rupture, when has the danger of rerupturing past?

I’m just starting week 5 of NWB. This is longer than is recommended on the protocols that I see a lot of you are following. It’s also longer than the nurses at my hospital thought I should be in a cast, but the doctor ‘was adamant’ and I didn’t feel up to the fight.

I like to hope that the extra time in plaster will have allowed the tendon to heal extra well, but the information that you all seem to have suggests the opposite. Oh well!

Now I have adapted to being in plaster quite well. I certainly have no problems sleeping in the cast (in fact I’m sleeping a massive amount), and I have tools (the iwalk, a knee scooter) to allow me to live pretty normally. I feel like I’ve forgotten what life is like when you can just walk around normally.

Anyway I have a question that I’ve been wondering about. When I switch from NWB to PWB, will life actually be *harder* for a while? At the moment I am whizzing about on the knee scooter, but I guess I’ll soon be hobbling very very slowly on the crutches while PWB? Will I be able to e.g. do the school run like this (1/3 mile there, 1/3 mile back)?