The Long and Winding Road

I only realised a couple of hours ago that today marks my six month anniversary since the rupture.  I guess this is in itself an achievement.  Only a few months ago, my ENTIRE thoughts were dominated by the rupture.  That such a significant date almost passed me by is indicative that the injury is not such a significant part of my life right now.

I visit this website less often too.  From a daily visitor while in plaster, I visit now maybe once every couple of weeks or so.  I guess again this reflects that I think about my achilles less frequently.  I am indebted to the site and to those who took time to write of their own experiences and comment on my postings.  At a very depressing time, seeing that others have been through it and come out the other side is very important.

A quick progress update.  Generally things are improving, the leg is stronger and I am now able to do some jumps, as well as calf raises and reasonable jogging.  I am currently jogging for two and a half miles in around 25 mins.  Nothing like my pre-injury pace, but faster and further than since rehab began. I don’t feel pain too often and any morning stiffness in the leg wares off pretty quickly once up and about.

I notice from the marathon tracker that I am almost onto Manhatten island!  That has been a target of mine since the day I set up my blog.  Progress again.

All the best to everyone.

Right, I haven’t posted for a while, mainly because I have been a bit annoyed and frustrated about my treatment from the UK NHS hospital. 

After the cast was removed (conservative protocol followed as rupture diagnosed as at the top of the tendon by the calf muscle) I developed a painful lump in line with the ankle, at the back of my leg.  This was causing me a little pain with every step I took, but also had the effect of never allowing me to forget about the rupture.  The physio was pretty confused by this lump, as I had said the rupture was at the top of the tendon, but he was convinced this marked the site of the rupture, and could think of no other explanation.  After a few weeks, with some minimal progress (it still felt sore with every step), I went back to see a specialist who confirmed that the initial diagnosis was wrong, that the rupture had occured low down in the tendon.  Given that I had opted against surgery on the advice of two doctors, based upon a high up rupture, I was pretty depressed, especially as the surgeon also said that he thought the tendon had lengthened slightly and so I would lose some power from the leg forever. 

However, I am pleased to report that over the past three or four weeks, the pain at the point of rupture has pretty much disappeared and the tendon is only stiff and slightly sore first thing in the morning. I’ve also seen a noticeable improvement in what I am able to do.   I have begun single calf raises and on Monday ran a mile (1.6ks) on a treadmill and then ran 1.25 miles (2ks) again today (Friday).  With no adverse reaction to the jogging, I have been really encouraged, as these improvements have all come along in quick succession.  The only way is up!

So a lesson for those in the UK who are looked at by a non-specialist at an NHS hospital.  Ask questions, and try to get a second opinion.  Doctors do make mistakes.  Never really having been in  a hospital before, I was a bit too accepting of what was a very brief consultation and from that day forth my decisions were based on mis-information.

Once I had the final cast removed, the doctor told me that I was free to start physio.  He said he would arrange this through the NHS.  However, I decided to speed the process up by getting a private physio appointment at the Hampden Sports Clinic, which my girlfriend has used for PT on her shoulder following swimming and water polo problems. 

I booked an initial consultation and was able to be seen the following day.  So my first appointment consisted of the physio massaging my leg in an attempt to loosen up the achilles.  This lasted for most of the session, with him then providing me with some exercises to improve my walking.  Up until then, I was basically planting my bad leg onto the ground and pushing up from it, not walking heel to toe at all.  The exercises which were to be done four times a day for five minutes consisted of stepping back and forward on my good leg, which the stationary bad leg rocked forward on the toes and back onto the heel.  The purpose of the exercise is simply to re-train myself how to walk naturally again. 

The physio also told me to keep the leg elevated as much as possible to keep the swelling down, and also to just move the foot backwards and forwards whenever I was sat down to keep working the calf.  I was also cleared to go swimming.

I religiously did the exercises all week and returned for a second appointment this afternoon. 

Again, we started with him massaging my leg, focussing on a lump which has formed just above where the achilles joins the heel.  This is the only area which gives any pain when I am walking around.   

We then moved onto the static bike and tried cycling with very little resistance (just at level two).  I found this easier than I was expecting and the physio is happy that I cycle this week - although warned me against doing too much - just fifteen to twenty minutes, at very low resistance. 

He also gave me some new exercises, this time focussing on my balance, which again I am to do several times a day, twenty reps per exercise each time.  There are a series of three exercises.  The first is simply stepping from one leg to the other, rocking between the two.  The second is lifting alternate legs up behind me and the third is going up on tiptoes, with both feet grounded.  Again, I shall make sure I repeat these several times a day and also continue the stepping exercise from last week. 

I feel encouraged by the progress I am making right now and hope this continues in the following weeks.  As for now, I will now be going to the gym pretty regularly to cycle and swim. 

For those in the UK, the NHS physio team did get back to me last week to fit in an appointment with them.  Unfortunately, they couldn’t see me until 3 July, which was a month after which the doctor had cleared me for physio.  This seems another example where some better planning could help the patient.  It was known for two months when I was going to come out of the cast - could the appointment not have been set up then, and cancelled if necessary?

Back to the fracture clinic on Friday for that long awaited day when I would be freed from the cast.  Saw the doctor for a very short period of time, who after running his finger up and down the achilles announced that it had healed fine and I was free to begin physio.  He effectively discharged me from the clinic, saying I only needed to return if I or the physio felt there were problems. 

So, a great feeling to leave the hospital with no cast and to be able to have the leg fully weight bearing again, just under nine weeks after the rupture happened. 

It was highly opportune timing too, as I was due to fly to France the following day to attend my cousin’s wedding, taking place in Burgundy - right in the heart of the wine-producing regions - lovely!

So the next day Laura and I drove over to Edinburgh airport for our easyjet flight to Geneva.  I had brought the crutches along with me and they were to prove invaluable.  At the check-in desk, we were accorded priority boarding status and approaching a long queue at security, we were escorted through a side door, skipping the worst of it.  Onto the plane, we had extra leg-room seats held for us by the cabin crew.  All in all, most welcomed. 

The wedding was great fun and I took the chance - albeit after a few glasses of wine - to test out the newly healed achilles.  I pushed up and down on tiptoes several times and was actually quite surprised by the ease of doing so.  However, I was to suffer slightly the next morning, when the leg was quite sore and very swollen.

Indeed, while I haven’t experienced too much pain - just some around the heel, which seems to be pretty commonplace according to reports on here - the swelling has occured after every time I have walked on it for a few minutes or more. 

We returned from France yesterday, and am off to my first physio appointment shortly and will post again soon about what that entailed and what exercises I have been asked to begin with.

After nearly seven weeks in the cast I went back to the fracture clinic last Friday, for my foot to be casted into the neutral position.  Again, I wasn’t seen by the doctor, so I still have some concerns about whether the achilles has healed well, but I do see the doctor in two weeks time, so will no doubt find out then.

Anyway, once the new cast was fitted, the nurse gave me a slipper-type shoe to wear over the cast and told me I was now clear to walk, without the crutches.  This was a surprise to me, as I had understood I would be beginning to bear weight, but continuing to use the crutches while doing so. 

I was actually really nervous about putting weight back on the leg initially, fearful of damaging it again.  At first, I literally couldn’t get over the mental block at all.  Even when I did begin to use the leg, I was doing everything to avoid weight bearing:hopping, pushing off the toes of the damaged leg, using the crutches, you name it, I was doing it!   Anyway, gradually the confidence did come back and I began to walk again, without the crutches - obviously, once you do so for a few minutes you grow in confidence and soon forget all those initial nerves! 

So the past few days have been great.  I have pretty much ditched the crutches most of the time and can limp around pretty well.  It is only painful if I try to walk for a considerable distance, just moving around the house is fine and it is great to be able to generally live more normally again. 

Since the cast is doing the supporting, I guess the achilles could still be damaged, but obviously, I hope not.  One question I did have, is am I PWB’ing at this stage, or have I skipped to FWB?

Now less than two weeks left in the cast.

So it was back to the Fracture Clinic on Friday, for a cast change.  I was expecting to see the doctor again and was a bit disappointed to find out that the ‘NLC’ written on my appointment card meant ‘Nurse led clinic’, or no doctor present. 

So the old cast came off and while the nurses left me for a few minutes I took the chance to feel the tendon and move my foot up and down a bit.  I couldn’t find evidence of any gap in the tendon and I could lift my foot up and down easily and without any pain.  I’m not sure that actually means the tendon is healing, but hope so!

The nurses came back to fit the next cast, moving the foot into ’semi-equinus’ position.  So at last, a visible sign of improvement, in that the foot is now not pointing pretty much to the ground.  This cast is to stay on for two weeks before back to the Nurse Led Clinic for the the foot to be moved close to neutral and another cast put on for the final two weeks.  The nurse told me I would be PWB’ing on that final cast, which is good to hear. 

I also presented a pair of shoes to be sent off for a raised heal to be added.  I’ll wear them for six weeks, which seems like a lot to me.  I can’t say I am looking forward to the high heels!

The nurse also said I would be ok to go to France, to attend my cousin’s wedding, the flight being a day after the last cast is removed. 

I’ve also been reading about a clinical review which talks very favourably of the results of conservative treatment for patients seen within 48 hours of the injury occuring.  I am taking some comfort from it, despite it being some twenty years old. 

I also liked the introduction to it which quoted Hippocrates, the Greek ‘father of medicine’ who’s view of a rupture of the achilles tendon was…  

“that this tendon, if bruised or cut causes the most acute fevers, induces choking, deranges the mind and at length brings death’   

Another reason to consider ourselves lucky, that we weren’t living in Ancient Greece when our ATR’s happened.

Anyway, the review paper is here.

Just seeking some advice from those of you who followed a conservative treatment approach.  I am seeing the doctor for a cast change and foot position move on Friday, which is just under five weeks after my injury. 

Obviously, I’d like to know things are healing well, so can you suggest any questions which I could usefully ask.  In my experience of the UK NHS, the more questions you ask, the more information you get. 

Is it too much to hope that the Thompson test might show some signs of recovery?

Thanks in advance.

Laura’s mum was invited to a charity meal and auction last week. One of the after dinner speakers was Sir Chris Hoy, triple Gold medallist in cycling at the Beijing Olympics.

At the end of the event, Laura’s mum got chatting and told him of my injury.  She said he sounded genuinely sorry to hear about it and said that it was a terrible injury for anyone to sustain.  Anyway, he wrote a little note on the event programme. 

I nice touch, I thought.

So I went to see a private sports injury specialist the other day, to seek confirmation, or ortherwise, that the conservative treatment suggested by the NHS consultant was the most appropriate for me to follow. 

He started off by saying that his concern about the NHS was that they tended to offer conservative treatment as a first option for most patients, leaving surgery for those who had re-ruptured.  I guess this confirmed some of my fears. 

However, we then talked more about my particular injury and when I explained that it was high up the achilles, right where it joins the calf muscle, he was much happier in the NHS verdict.  Essentially, he agreed with the original consultant - the prognosis for healing is better in ruptures higher up the leg, the chance of rerupture is considerably lower and it is also a little more difficult to operate in that area.  He was happy enough for me to continue following the conservative approach although did say when this cast comes off in a couple of weeks time, if I have any concerns about how it is healing then I should come back to him and he could open the leg up and make sure all is well.  At the very least, he said, he would be able to clear out any debris from around the injury. 

So all in all, I came away pretty reassured and glad I sought a second opinion.  I wanted to make sure I am following the right path to recovery but now that two specialists, one from the NHS and one private, agree on the course of action I am pretty comfortable in what is taking place.  Without this second opinion, there would always have been that nagging doubt.

Anyway, it is also time to say say thanks: to those of you reading this blog and leaving comments - believe me I read them all;  to those of you writing up your experiences on this site - I have learnt so much; to my friends and family - for your support and to Laura, her mum dad and sister, for the day to day help which is so necessary in the early stages of recovery.