tendonblues’ AchillesBlog

So for some reason I had in my head 6 months as my “mostly back to normal” timeline. Not sure where that came from, but someone must have said it to me. Therefore I’m not too pleased about where I am at right now. I am a few weeks past 6 months and my AT still has significant swelling at “the spot” and my calf not only is weak, but really sore pretty much all the time, but especially when I am trying to exercise it. Now maybe the only people posting are those who are happy with their progress…? (I just did a quick search for “6 months” and I read about people jogging and hiking, etc… I’m in pretty significant pain still just trying to limp along) ANYWAY, I feel like I’ve been diligent (but not fanatical) about my PT for the last 4 months. Anybody else still struggling pretty hard at, or just past, 6 months?

Well, I am happy to say I have what I hope is progress to report. As of about 5 days ago I’ve been able to put more and more weight on my injured foot (in the boot only!). Up to that point, my heel and whole ankle area was way too sensitive to do more than just rest the cast on the ground and having the foot not elevated still resulted in a lot of pressure and pain from swelling. Then, quite surprisingly on Friday I thought it didn’t feel so bad and I started trying to “walk” around the house with two crutches and gradually over then next few days moved to using one crutch.

It is another liberating step to have that one hand free to carry things! Wow. Anyway, as of today I am now using a cane and the boot around the house, but still use two crutches on stairs and outside (I’m actually way faster on two crutches). My heel feels pretty tender after I’ve been up and about for a while though, so I usually elevate and ice after being upright for an hour or so. When I know I am going to be sitting for a while, I usually take the boot off more just to air thing out and because I am more comfortable.

Because my doctors have not provided any kind of treatment protocol, I’ve been doing my own excercises. Usually 3 or 4 times a day I do 10 reps of plantarflex/dorsiflex to 90, then 10 “foot circles” clockwise, 10 counter-clockwise, 10 more plantar/dorsiflex’s, 10 “toe curls/pull-backs”, 10 more plantar/dorsiflex’s. I can feel slight pain/stretch/burn when I dorsiflex to 90 degrees (I hope I am NOT pushing -I’ve read too much about healing long), otherwise ROM seems pretty good. My toes are a bit weird though: the middle one doesn’t pull pack as far as the rest, and the outer two seem a bit “droopy” as well, but I’m hoping that is swelling interfering with them somehow: my foot is still observably puffy.

Anyway, having resigned myself to this 6-12 month journey, I have been pleasantly surprised by these recent developments. At the beginning of each stage it has seemed to me like it is going to be forever and then suddenly one day I wake up and something has changed and I’m into a new stage. Gives me hope I guess. So I hope all the rest of you are keeping your spirits up and that if you haven’t experienced this sort of “stage change” yet that you can look forward to doing so.

Day of the injury sent home in the cast. NWB. Pretty painful if not elevated. Mostly related to swelling I think. I was lucky in that my kids were in school all day and the job that I just started 2 months ago is only half-days and mostly computer work, so I was able to go back 2 days after the injury. Sat with leg elevated on another chair at work. Felt bad asking co-workers to get me things so often, but they were really great about it. Looking back, those first 2 weeks did go by fairly quickly. I was definitely popping ibuprofen and acetaminophen, but I didn’t have to fill the morphine prescription I was given.

The day after the injury, I figure I should find out what the heck I’ve done and how best to deal with it. Where else but the internet? I find a few medical sites that describe the anatomy and symptoms of the injury. Moderately helpful at that early stage since I don’t know anything about Achilles tendons. Find plenty of info about how long the recovery time is and about how surgery is the only way to go. Am starting to feel like I’m going to have to get it done one way or the other. Then I find this site. Super informative in terms of the surgical vs non-surgical debate, but also strangely comforting just to read others’ stories. Eventually find normofthenorth’s blog, which finally convinces me that maybe it’s just as well they didn’t do the surgery on me and I can at least wait the 2 weeks until my first appt. I’m still worried though that when I get there, they’re going to say “You need to have the surgery” and I’ll just be 2 weeks behind in my recovery. 

After 2 weeks I go in to meet the ortho armed with all kinds of printouts from here (UWO protocol, AAOS letter, other sample treatment protocols). The usual waiting, even though I have an appointment. They remove the plaster. My ankle feels like it’s made of glass and I’m afraid to move it at all. A resident comes and talks to me: asks if I’m the guy who needs screws removed. Not. He finally figures out who I am and has a little look-see and a feel. Says: “Yeah, we’ll be keeping you immobile for another 4-6 weeks, that’s the non-surgical protocol”. He quotes most of what I now think of as the old wisdom. Then the actual ortho specialist makes it to me. He is much less gentle with his prodding, but this reassures me slightly that even injured, my tendon is maybe not as fragile as it feels. Then he says he can’t actually feel where the gap is. Not sure what that means, but the he surprises me again by saying: “You know, whether it is a full or partial rupture, I wouldn’t have recommended surgery 2 weeks ago either”. He actually refers to the UWO study and gives the resident a little lesson in front of me. I don’t have to pull out my printouts. So that’s something anyway. He asks if I want an ultrasound, but after further discussion, I figure out the treatment protocol will be the same no matter what the ultrasound might show. Since I am already tired of waiting around the hospital, I opt not to have it done. They give me an aircast saying I can take it off 2 or 3 times a day (i.e. to try to move my foot and to bathe), but not more than that and I should definitely sleep in it. The resident promises to email me their treatment protocol since “…there’s something wrong with the printer here or something”.

They send in a physio who shows me the few little moves I can do (point my toes and then pull them back no farther than 90 degrees and a little bit of supported heel rotation). Then, funny thing: he looks around as though to check if the doctors are still there. They are not. He says: “You know I actually recommend you take off the cast as often as you want, you know if you are just sitting around, and move your foot as much as you want as long as there is no pain and you don’t dorsiflex past 90″. Hm. Not getting a completely consistent message, but thanks to all the extra info from achillesblog.com, I feel reasonably well equipped for the next 2 weeks. The resident never did email me the treatment protocol they are expecting me to follow though…

The aircast is a huge improvement! So glorious to be able to air out/cool off my leg and foot. So nice to be able to move the ankle a bit. Baths are significantly easier, though somewhat scarier without the protection of the cast.  

As I mentioned, most of my pain seemed swelling related, near the end of the first 2 weeks, the worst pain was actually in my upper calf, quite far from where I would think any Achilles rupture would be. I thought this was cramping from carrying the heavy plaster around, but it continued and even got a little worse after I got the aircast. I scared myself reading some posts about deep vein thrombosis and resolved to phone to move up my next appointment. Luckily, with some more consistent icing my overall swelling seemed to finally be going down and that upper calf pain has now almost completely subsided, so I will wait until July 9 for the next appt.

There are 2 hospitals in our town.  I waited at the usually faster emergency for 3
hours until I finally had a doctor come in to talk to me, look at my leg, feel
my tendon, and pronounce it a complete rupture. He then sent me off to the
other (usually slower because of ambulances) hospital to be checked by an
orthopedic specialist and scheduled for surgery. They gave me a set of crutches
and sent me off with vague directions. Looking back, I’m glad there was no
mishap in transit (I had no cast or boot or anything on my ankle)!

My wonderful wife safely chauffeured me to the other
hospital where it took us almost a half-hour to figure out where we were
supposed to go and then waited another hour and a half for a doctor to show up.
Now, just in case I’m sounding a bit frustrated here, I certainly was at the
time. I probably shouldn’t complain. I’m sure there are longer wait stories out
there.

Anyway, this very nice resident came in, heard my story,
looked at my leg, felt my right and left Achilles, and confirmed the full
rupture diagnosis. He then told me about the great surgeons who were currently
working and how they might even be able to get me into the operating room later
than night or the next day. He went out briefly to confer with somebody, then
he came in and said: “There’s something I forgot”. He then did the squeeze the
calf trick (which I now know as the Thompson test) and came to the conclusion
that there just might be a few fibres of my Achilles still attached. He left
again and again came back saying: “There’s just one other thing I’d like to try”.
He had me sit on the edge of the bed with my feet hanging down and asked me to
point my toes. Lo and behold I could (sort of), so he was now convinced it was
only a partial rupture and therefore surgery would not be considered. I had no
idea if he knew what he was talking about or not, but I have never had surgery
of any sort and would prefer not to, so I was content with that decision for
the moment.

He put a plaster cast on me (it was actually open at the
front and wrapped in a tensor bandage), told me the ankle would be immobilized
for 6-8 weeks, but that someone would contact me about a follow-up appointment in
about 2 weeks. Then he sent me home.

The next day I found AchillesBlog.com

Hello everyone,

First, I want to thank Dennis for setting this site up. I know it’s taken me a while to get blogging myself, but I have been lurking about reading lots of posts and collecting valuable information from the day after my rupture. I certainly have received more info here than has been supplied by any of the medical professionals I have seen so far. But more on that later. I guess I should start at the beginning.

I ruptured my Achilles tendon on Sunday, June 3rd playing soccer. I had one friend who had had it happen to him about 10 years ago and had heard a few other stories, so I guess that’s how I knew as soon as it happened that that’s what it was. I was soon to learn from the doctors that I am pretty much the “textbook” patient for this injury: male, of a certain age, returning, after a prolonged absence, to an activity that I had once participated in quite competitively.

The irony is that this was to be a low key, non-competitive, no-contact, co-ed, Sunday afternoon soccer group. I had had previous issues with my knees and was really trying to avoid further injury. I figured if I got hurt, it would be a knee. Everything had been feeling very good for the last two years or so though. I’d been doing quite a lot of yoga and had felt great (other than my cardio!) during the one or two pick-up soccer games I’d played in the fall and early spring. So my wife and I signed up to this group to do something active and together -like most couples with jobs and a young family, we don’t seem to be able to find a lot of time to be together.

I warmed up for the game. Perhaps not a comprehensive workout, but a jog around the field, some light stretching (including calves/achilles), a bit of ball passing. We played for about 30 minutes. I felt great all around. We took a water break and returned to the field. I was playing forward, my team had the ball in our defensive zone. I pushed off my left foot (not terribly aggressively btw) to position myself to be a target for a long pass and “fwop”.

I heard it, as did several of the other players on the field. It felt like my shoe came off the back of my heel. Which is actually what I thought had happened, but from my crumpled on the pitch position, I could see that my shoe was still on. It did not hurt terribly, but I could teel something was just wrong with my leg. My foot was floppy. I was worried about swelling, so I took my shoe and sock off fairly quickly. One of the other players brilliantly always brings an icepack to games, so I was iced and elevated immediately. Then at emergency within 30 minute. Where I waited for 3 fairly excruciating hours to finally see a doctor.

To be continued…

Chris