The first 3 weeks… coming to terms with it
Day 1: It started with a bang
I was having so much fun. I was playing in a skate park with my kids, my husband and friends. We weren’t using skateboards, but instead we were just running up the half pipe, pulling ourselves up, and then sliding down again. I felt very free, and very strong, and the only thing that was hurting was when I bumped down the slope holding my daughter’s hand. It was a very steep slope up to the top, and it needed a fast run up. I was getting better and better at getting to the top and hauling myself over the edge, but I wanted to sort of run onto the top edge without putting a hand down to heave myself up. I started my run up, and then fell over at the bottom of the half-pipe. I looked up, thinking that the teenage boys nearby had dropped a skateboard onto my ankle. I was asking what had happened, and my husband was looking down at me from the top of the halfpipe, still smiling. We had all been cheerfully falling over and getting up again as we tried to run up, so he didn’t realise anything was wrong. Then gradually the atmosphere changed and everyone came down to get me up. Then I was half hopping, half being carried to the car, complaining that I could see stars, and my ears were ringing. In the car my husband found me some lucozade, and as I drank it the stars and ringing went away, and the back of my ankle began to really really hurt.
On the way, my son was complaining about the tree top adventure we were set to go on that afternoon. We had a very fun day planned. I had been for a run in the morning, then to church, then we met at the skate park, and our next step was to go to the tree top adventure. This wasn’t going to happen. Instead, we went to a&e. We saw a triage nurse quite quickly, who gave me some painkillers - after which I felt more or less okay, but still couldn’t walk. After a longer wait, we were called through to see a doctor, who examined my ankle. He said that I had ruptured my achilles, and went off to talk to the orthopaedic surgeon. After this we were taken to another room where a nurse plastered the lower half of my leg, with the toes pointing down. He explained to us that it would be 6 weeks in plaster, with the angles changed along the way. Then some physiotherapy to get me strong again. This sounded pretty bad, but since then the timescale has increased a lot… up to 12 weeks in plaster has been mentioned!
Coming to Terms with it
We went home, and I managed with a combination of crutches and hopping. The next day I was miserable. I literally howled with the misery of the situation! I kept thinking ‘if only I hadn’t…’, ‘what if…’. It was like I couldn’t believe that this was the new reality - surely I could undo this error somehow? But as the days passed I began to come to terms with things, accept that this was the situation, and start making the best of it. I managed to look after the kids - which as I was supposed to be working from home involved successfully getting them up and breakfasted and taking them to their activities, and then getting them home and making their tea. I found a friendly taxi driver who I called a few times (and who I discovered had injured his knee once very badly playing football… in fact I found that most people have some injury story to tell, and they tell you when you’re in crutches!). I asked my mum to help one day too. We met up with some friends and their son a couple of times and had a lovely time. Things weren’t so bad.
Equipment
Investing in some equipment helped - I researched the things I need, and I guess I splashed out a bit. I bought the waterproof cast cover from limbo, some gel pads to make crutching easier, I bought the iwalkfree (pegleg in the UK), and hired a knee scooter as recommended by the NHS. I kept buying easy going books to read when I felt like I needed to rest. I worried I was being extravagant, but these things made a lot of difference once they had arrived and I had got used to using them. My pattern was this:
1. Out and about on adventures (usually chosen with flat paths in mind - no scrambling up rocky paths obviously) I used the knee scooter. I also used this to get into town, to take the children to school etc. It was actually sort of fun to use - particularly on nice flat cycle paths.
2. At home I used the iwalkfree. This meant I could basically do everything I would normally do - make meals, tidy up etc. There were just a few household tasks that I found impossible - carrying a tray of empty cups downstairs for example! And I also stopped trying to do the washing, and my husband took care of this after work. I took the iwalkfree to people’s houses if I knew I would be there for a while… once we went round the corner to a friends house me on the knee scooter with my son carrying the iwalkfree for me to use when we arrived!
3. I used crutches when I was going to be somewhere public, mostly indoors with steps (e.g. to take the kids to the local indoor climbing centre). I didn’t like wearing the iwalkfree too much in public partly because it draws a lot of stares. I also plan to use the crutches to go into work: crutch down to the train station (very near us), onto the train, and then from train to bus, and then from bus-stop to my office (very near again). I won’t have to go in very much on crutches, but I felt like I really can’t miss the things I have scheduled.
Day 6: Second Hospital Visit - the Fracture Clinic
This was a bit of an emotional rollercoaster.
When I had left a&e on day 1 with my plaster on and the toe pointing downwards, I was basically pain free from then on. I could move my foot around a bit inside the plaster, and it felt fine - it didn’t hurt. It only hurt if I lay on my front and tried to point my toe - something I had been asked to do on day 1 at a&e, and I was curious to see if I could do it (the ability did come back gradually over a couple of weeks). I guessed that I can’t have done anything all that bad - probably just a small rupture if anything.
When the plaster came off, I saw the bruising around my foot, and realised that something had indeed gone wrong. Then when I tried to move my foot very gingerly so that it was less pointed, I realised that yes - there was a problem! But it looked okay-ish apart from the bruising. The doctor came along and felt my ankle very carefully. He said these magic words: ‘It appears to be intact. But I’m going to send you for an ultrasound to see if there is a partial tear’.
When I got to the ultrasound, it was a different story. ‘Yep, you’ve ruptured your achilles’. He explained that the ends were 1cm apart, and with that gap it was not obvious whether or not I should have an operation. He also said that the tendon was thickened, and we talked briefly about why that might be (running, getting older…). I was upset to discover that all was not well with my tendon before the rupture- but also it kind of helped. It stopped all the ‘if onlys…’ - I guess my tendon was in bad shape even before we went to the skate park! I am very hungry for information about how to look after my tendon and get it into good shape in the future.
Then we went back to the consultant, who said there would be no surgery. I burst into tears - I think because I’d read that surgery makes for a better outcome etc, and because the ultrasound guy seemed to think I borderline needed it. The doctor was kind, and reassured me that I was healthy and would heal well. He said that if I insisted he would talk to colleagues etc about scheduling me in, but either way I now needed to be put back in plaster. Now (2 weeks later) having read more, I am glad that I was not given the option of surgery, but I do think that the hospital experience would be a lot less stressful if everyone was on the same page. It feels like you need to figure out the best treatment all by yourself, and then negotiate some sort of political system to actually get that treatment.
So then I got my new cast - fibreglass this time (purple!), with toes still pointing downwards - and a load of needles for me to inject myself each night (to thin the blood I think), and a new appointment for 2 week’s time. We left the hospital and went on a previously planned 2 night trip 200 miles away to visit family. The trip was good, and the next 2 weeks went well. It seems to be a very good idea to organize nice things to do - to see people, and get out and about to places you can manage. I am trying to be nice to myself in these sorts of ways, and I don’t think I have ever really enjoyed just going to a shopping centre before, but now it feels like quite a fun outing!
Hungry and Tired
Ever since the rupture, I’ve been wanting to sleep a lot. I don’t know if it’s the healing itself, or the emotional stress of it, or the sheer physical difficulty of getting about. Anyway towards the end of the day I always seem to get very tired, and an 11 hour sleep is not unheard of!
I have also been hungry. That’s easing off now, but I was very hungry for a while. It might be the healing, but I think it might equally just be not exercising somehow. In any case, the strategy I have hit upon is basically to only eat healthy things. I can eat whenever/as much as I like, but no cakes, biscuits, crisps, chocolate - just healthy food. Occasionally I have had a square of very dark chocolate, and I had a flapjack that the children baked, but basically I have been sticking to the rule. It is pretty much the same rule that I followed in pregnancy. I think it’s a good rule for when you are asking your body to do something amazing (like grow a person, or even just a new tendon), as you can be sure you are getting all the nutrients you need, but you don’t get into the habit of just overeating!
2 1/2 weeks: Third Hospital Visit
My purple cast came off, and I was relieved to see that my leg looked fairly normal. A bit smaller (but my calves are small anyway), and a bit hairier (ditto to be honest), but the bruising seemed to have gone. A consultant came in and stretched my foot upwards a bit - until it hurt a bit but not too much. Again, I was interested to discover that there was something wrong - that there was something it couldn’t comfortably do (i.e. stretch in a normal way), as it had felt so okay in the cast.
He seemed not to have all my notes. He asked what had happened last time, and I had explained that I had had an ultrasound, and then the cast. He said ‘ah, so the ends met then?’. I said - ‘I don’t know - but anyway the doctor decided to go the non-surgical route’. The consultant said ‘you mean you decided?’. But I quite definitely hadn’t decided (though I don’t regret the decision that was made for me!). The consultant looked a bit shocked. He asked what I thought would be happening next, and I began to talk about the boot. He said that the risk of rerupture was too high, and I needed 3 more weeks in a less pointy-toed cast. Then I could move to the boot. I felt okay with this. Then we went to the plaster room - and the nurses were all really surprised as they said the normal step at 3 weeks is to go into the boot. They went to double check, but apparently he was adamant. I had the option of asking him to come down to the plaster-room for an argument (I couldn’t go to him as I had no cast on!), but without his agreement they couldn’t just give me the boot. I didn’t feel up to the fight, so agreed to the cast. The plaster nurse really stretched my foot, and it hurt. I worried that she was stretching it too far, but in fact the cast is still not close to 90 degrees, and by a few hours the pain was totally gone.
It’s now 5 days since that appointment - about 3 and a half weeks since the rupture. I have an appointment in about 10 days (I got it moved a bit earlier to avoid a work commitment clash). I have renewed my knee scooter rental, and I am so looking forward to getting into the boot and partially weight bearing… I hope this is what happens at the next appointment! I have been reading the advice stating that I should already be pwb, and I don’t know what to do about this, except push hard to be in a boot at the next appointment. If I start pwb at 5 weeks, should I just follow the protocol as best I can from then on? Or will things have already gone wrong?
