My Journey Through an Achilles Tendon Rupture
Phase 1 Day of injury to 2 weeks post surgery
This is going to take the form of long blog and daily diary. I wrote this reflection for myself and for those who will invariably go through the same journey. Depedning on your current fitness level, support structure and work some of what I have written will. not apply to you but we will all share similar challenges and I hope that this writing offers up some ideas and some motivation. I’m a firm believer that much of life neither is out right good or bad, its what we make of it and how we are able to shift our perspective in each situation. I suppose some of this writing is practical but it is also philosophical. Injuries, disease, time away from our normal routine can give us an opportunity to reflect. I’ve tried to do that here.
Day 1 Thursday April 25th
I Was excited to play in an upcomign squash tourney, albeit a bit nervous about my body. I didn’t feel great going into the match but none the less I was doing very well. Over hitting the ball at times but I was cruising to victory when in the last point my achilles ruptured.
I knew right away. In a bit of a shock I rushed from the club as a I knew I needed a boot and to get the care process started. I think I was also embarresed that such an injury would happen to me. I try to keep my ego in check but on a daily basis I espouse the virtues or exercise and health, I felt like an imposter. My rational self knows that injuries happen, they are a part of life, and if catastrophic injuries occur to professinal athletes they can happen to anyone. Even so, I was initially a bit crushed.
I got to St. Paul’s at 830pm. I was there for a few hours but I got most of the care I needed. I got a boot to protect the site and keep the ankle plantar flexed. I was lucky to chat with the orthopeadic surgeon and get an appointment for monday morning. I knew the sooner the process started the better, especially if I were to go the surgical route. Although in my practice I have only every seen non-surgically repaired achilles rupture I knew that there was compelling evidence for the surgical route. During the quick assessment that evening, surgery seemed like the best choice.
I slept well in my sweaty clothes and my big boot. The pain was manageable and I didn’t take any medications.
Boot to keep things safe before casting on Monday. If possible a cast right away would be preferable. It is much more comfortable.
Day 2.
My first day at home. I only had crutches at this stage and following the care protocol I was non-weight bearing. It was incredibly hard to manoeuvre and make food with my hands tied up. I tried a few walks to get fresh air and I was able to do seated weights and pushups. By the end of the day I had procured a peg leg. At first i was a little tentative and my balance was not great but with practice over a few days I became quite nimble. Within the house the peg leg was great but walking any distance was a challenge, and the boot dug into my shin. At the time I had reflected, “We will see what practice does.” Three weeks on practice and a cast helped a lot!
A previous client was very generous and brought this to my house:) If you are physically able the iWalk is awesome.
Day 3. Saturday
Saturday at home. Was mobile in the kitchen, able to help with some cooking and cleaning. I also need to make a decision around work. My type of physio is very active and the space I work in usually requires some set up, I knew I could us the gym but if I were to have surgery it would probably mean lots of start stop and reduced hours. In the end I decided to take advantage of my disability insurance and go on leave for a month. I was sad to let my clients down but the conversations were also uplifting as so many of these people have become my friends and were really just concerned about my wellbeing. It was touching.
Day 4.
Not much pain, sleep is good. Able to do 20 pushups multiple times through the day plus seated shoulder press. My walking is improving. I’ve gone from 3.6 km Day 1 to 5km today. Eventually I would work up to 7 plus km. My goal is to get to 10km before my follow up on May 22nd.
In other fun news for the day, I pulled a muscle as I bent for a toy, playing with Mackenzie. I tried to be conscious of how much I was doing but the body is just slow to respond these days. It is frustrating but I know it is a part of the journey. Sore this morning but hopefully will relax through the day. The kids have been great. Danny and I played risk for the first time. Mackenzie and I have played lots together!
Day 5.
Monday following the rupture I got a cast in full plantar flexion. This will make things easier come the day of surgery.
Surgery is booked one week from today. Prior to surgery I’ll have the cast bivalved (cut) so the achilles can be accessed easily.
The cast was so much better than the boot - it dug into the iWalk a little but much less than the boot. You can see bandages on my knee from the squash match! I had to sign a few papers to agree to the surgery. The meeting with the surgeon last all of 3 minutes. It was clear that the rupture was complete and that if I ever wanted to get the same tension back as my right I would have to undergo surgery. As a physio I have only seen non-operative patients. It seems that in some of the cases the surgery may have offered a better end result. The surgery has its risks but with a full rupture and the hope to get back to competive sports, surgery was the better option for me. Here are two good reads on the topic. This is my a local group of doctors, my surgeon included - Link and this one comparing surgery vs non surgery using a specific criterion for both - link.
Day 6
Did 6km of walking. My best yet. Ready to try the gym today and will get back on my computer to do some work and re-engage with some of my clients
How the iWalk (peg leg) works
Day 7-9
Overall the week is going well. Exercised and walked more each day. Was able to walk to the park with mackenzie - she is quite the climber:) I’ve been reading every day. I’ve been diving into some African history. It is fascinating, devastating, and eye opening.
Mackenzie’s favourite activity - climbing poles.
Surgery Day 12
I had a bit of time before my check in at St Pauls at 10.45. nice little relax on a bench and went for a walk. So beautiful in English bay. It felt good to take a moment. It’s funny how hard that can. Or how easy it is to fill a day.
It was an easy process getting checked in and by 11:30 I was getting admitted to the surgical rooms. The first step was getting a nerve block from the anesthesiologist. He did a nerve block to my sciatic / sural and peroneal nerve just above the knee. Over ten minutes my knee down to my toes went completely numb.
I was then taken to the surgical room face down on my bed. I was awake during the whole procedure but could only feel them pulling and pushing around my ankle. I was interested in what was happening so they took some photos and video. One photo is below - its graphic, with blood, so skip it if that is not for you. The technique used included a suture of the achilles tendon plus anchors into the calcaneus. This means drilling into the bone which probably increases post operative soreness and makes for a more complicated surgery. The end result, however, is more robust.
The whole surgery took 30-40 minutes. I recovered briefly with the nurses where they gave me some cranberry juice and a very long list of medications! Thankfully my wife was able to fax them to our pharmacy for easy pick up. You definitely want to do this on the day of, because if you missed the pain medications you would be in for an incredibly hard night.
I thought I had followed the pain medication protocol closely but I think I could have been even more aggressive as the first night was not good (I think there were six pain meds and I only took three of them - hydromorphine, tramadol, and gabapentin). Around 11 pm the nerve block wore off and it was really hard to get comfortable. Thankfully my wife is a nurse and she cared for me beautifully. A part of me felt guilty for the pain as my surgery paled in comparison to some injuries and surgeries. I couldn’t help but think how uncomfortable my brother must have been after two open heart surgeries, or any victim of a large crash! By the next day the hydromorphone (I was only given 10 capsules) and tramadol (short term pain) were dulling the pain nicely, however the side effects - drowsiness, constipation, and nausea - were not great. The other medications they prescribed were gabapentin (post operative neuralgia), naproxin (nsaid), aspirin (fever, pain, swelling, blood clots), 5 days of anti-biotics, and vitamins - Vit D (bone health), Calcium (bone health), and vitamin C. I suspect the vitamins were to aid the healing process as the calcanues was used as an anchor for the achilles tendon.
Day 13-16
Not a lot to report during these days. I am thankful to have a partner who could help with the kids and take care of my needs. I can see why for many people the surgical route would not be their preference as the surgery and subsequent recovery definitly set you back. I ceased taking any of the strong medications after day 3 and used tylenol and aspirin as needed. I really didn’t like the side effects of the pain medications but I am sure this will be different for everyone.
I tried to get a little fresh air, I ate well, and I slept at for at least 9 hours each night. Which I have continued to do throughout the recovery. I would usually relax with my leg up while reading or listening to a podcast. I enjoyed these two podcasts.
Prof G with Rex Coleman - facing your demons. I really enjoyed listening to Rex, a sad but powerful story.
Arm Chair expert with James Doty - a nice discussion compassion and the important things in life
Day 17-18
I tried for a light workout on Friday but it was probably too soon. I may have a caught a little bug from the kids as all through the weekend I was lethagic and uncomfortable.
Day 19
By Monday, or a week post surgery I started to feel more like myself. The discomfort in the leg would be gone by the morning and I felt mostly refreshed. I started walking more, I took transit, and I got to the gym again.
Day 21
Really good workout today. Did the entire workout in standing. 30 minutes. Even able to build in a heavy single leg deadlift and military press. My single arm swings with support also worked well. Happy with the progress. Back side of the leg tired again. Making progress towards 10km mark.
May 15th
I was able to take Danny to the golf course. I may have only hit a few puts but it was nice to be down at Fraserview. It’s such a beautiful place.
May 17th
Had a fun workout with friends and walk 8km my most yet. Leg and body are still tired by the end of the day as expected
May 18-20th
The peg leg really offers a lot of freedom. Although it is a bit irritating on the knee and shin I am able to walk well. I did a 3 km walk through Terra Nova park and would feel very comfortable at pacific spirit park. I was able to hit putts at the golf course and can create an abbreviated swing.
I am getting excited to start exercising and rehabbing the leg and calf. It will be a great test of my fitness and skill. This will hopefully begin May 22nd at my two week follow up post surgery.
May 21st
Two weeks post surgery. Time for an X-ray of the ankle. There has been something easy about the injury. Once you get over what you can’t do you focus on what you can do. This allows injury to heal and gives you reason to live.
When pain is pervasive and the cause is less obvious it can be really hard.
Following the initial injury I had very little pain. It’s Fascinating to think that my tendon was ruptured and I had so little pain. It was irritable but because it was immobilized I didn’t give the area and cause for danger. Our nervous system creates alerts when it senses changes in gradient - pressure, heat, chemicals. Because I was not loading the tendon it didn’t sense the rupture (or lack of tolerance to load)
The pain following the surgery was far greater. In this case there was more the area to sense. Skin cuts, sutures, bone drilling, sutures of the tendon. Bit again even in this state after a couple of days as long as the stitches were not touched I didn’t experience a lot of pain.
May 22nd - two week follow up. Footbridge Clinic.
Eugene helped me again with my cast. He removed the splint, wraps, dressings and stitches. He reapplied bandages which I keep on for three more days prior to checking the wound once again. If the wound looks good I can shower and clean the wound. I have able to shower with my leg outside the shower. I sit on the ground and use a wand head. This wouldn’t be possible for everyone but I have the flexibility and strength in the right leg to get down and back up.
I had a quick check in with the surgeon who looked at the wounds checked the health of the tendon and reviewed a few precautions.
The last visit was with the physio. He reviewed the first set of exercises, expectations of pain, and how to safely walk with the crutches. At this stage, 25% weight bearing, I need to use two crutches and use to technique. 25% is a hard number to quantify but I don’t think I would want to put much more weight through it. I think if I had needed more support from the physio he would have been able to give me the time. Thankfully I was confident with his instructions and the short visit was suffice.
The visit took a long time but the care was good. I am going to end this blog here and start new one for the second phase of the journey.
