The Achilles heel of “Old guys”
As all good stories start; “so there I was”… Coaching my last extended season wrestling practice of the year. Early May with nothing but sunshine and summer fun in my future when it happened. Playing a fun game to send off the kids after a very long wrestling season. We opted to have some fun and play game to lighten things up a bit, no competitions remained, just some final technique review and solidify the fun aspect of the grueling sport.
I won’t go into great detail about the game, but basically we had lined up half of the group on either side of the mat and the object was to beat the other person called out to the enter where a rolled up towel lay and bring it back to your own side. After a few fun rounds, I crouched ready to make the sprint to the center when my number was called and like a 42-year-old tiger I leaped for my first step towards center only to hear what I thought was either a gunshot or the sound of a large metal cafeteria table falling onto the back of my leg. When I turned to see no table or gun and the sickened faces of the kids standing around me, I knew immediately what had happened… There went my Achilles.
Sounded like a Gunshot
When I turned to see no table or gun and the sickened faces of the kids standing around me, I knew immediately what had happened… There went my Achilles.
This was not an old injury or even a weak point from years past, wasn’t a bad ankle. I had been in relatively decent shape, wrestling some with the kids over the winter, I lifted religiously every day and walked or ran a couple miles per day 5 days a week, so even at the ripe old age of 42, I was a little surprised that such an injury had occurred in what I thought was a pretty innocent movement.
As I am a bit of a fainter, I spent the next 30 minutes or so fainting and feeling pretty nauseous as it wasn’t super painful, but certainly could feel that something was not right. I made the dreaded trek to the ER, where I was disappointed in the lack of care and bedside manor, but confident that after x-rays showing nothing was broken (thank you captain obvious) they misdiagnosed me with a “sprain”. I had a hard time swallowing this as the sound that came from the injury seemed to point to what I felt was fairly black and white.
Day 2 I followed up with my PCP who agreed that this was most likely an acute tear of the achilles tendon and referred me to an MRI and an orthopedic specialist. I’ll save the gory details about dealing with the insurance company for a different post. But I had an MRI done a week later. Results a few hours later read “full thickness tear; 8mm above heal”. So as I suspected, this was a full tear or complete rupture. 8mm was on the high side of where these typically tear, which becomes important when deciding what path to take regarding surgery or non-surgical repair.
A few days later I met with the orthopedic specialist who laid out my options. To operate or not to operate, that is the question! His input leaned me towards avoiding surgery, which did not hurt my feelings. But being such a high tear, I was told the likelihood of the surgery being successful would be slightly lower as what they would be reattaching would tendon to some muscle.
The one thing the ER did manage to get right was they put me into a hard half cast splint with my foot pointed down at roughly a 30 degree angle. Which as it turned out was helpful in that the space between the 2 torn pieces was not as much as it could have been, so a non-surgical protocol was possible. And this was the route that I took. So that day they put me into a hard cast, foot pointed down at 30 degrees for 4 weeks.
After the second week on crutches, I had never felt so completely useless in my life, so I stumbled onto the iwalk 3.0 hands free crutch which was an absolute lifesaver. Read more about it here. Being able to “walk” hands free was like a gift from the injury Gods! Read more about the iwalk crutch here, what a life saver!
The savior or lower leg injuries
After my 4 weeks in the hard cast, I returned to the Orthopedic specialist. The hard cast was removed, and some gentle testing showed that my calf and heel were miraculously connected once again! The two torn parts clotted and had made progress in their reunion, I was able to easily push down with my foot again. Next contraption would be the nifty VacOped Achilles boot. The Boot is a hard, almost knee high boot that can be removed with the Velcro straps to shower, which sounds small, but what an improvement! Using the new silicone bags was light years ahead of using garbage bags and duct tape, but still a hassle.
What is unique about this VacOped boot as opposed to the typical ankle sprain or foot injury boot is that it articulates at the ankle. The interior lambs wood sleeve has a vacuum insert to provide the rigid stability and this lives inside of a plastic exoskeleton. The articulating feature allows for periodic adjustments of the angle, so as the Achilles heals you are able to return to a normal range of motion. It can be locked at between 30 and 0 or can be opened to a very strict range of motion. The 2 heal wedges allow for progressive weight bearing as you move through the different angles and really provides a great platform for graduated range of motion and strength training. Also as you progress, the ability to remove the boot all together allows for normal physical therapy with bands etc. Read more about the VacOped boot here
From week 4 on, I made the weekly adjustments with the locked angle of the toe point up to a 0 degree or “neutral” position. Once there I was able to start some weight bearing. after weight bearing at neutral for a week I began the process of “unlocking” angles for increased levels of articulation until after another 8 weeks was at the point where the boot was unlocked to its Maximum range, which allowed for as normal a gate as is possible given the injury and the massive plastic contraption strapped to my leg.
Finally at week 12, I was given the green light when safe to start weight bearing without the boot! My Dr. set my next appointment for another 4 weeks out, told me that he expected me to walk back into his office without the boot and sent me to Physical therapy.
Progress from there was slow. Therapy at twice per week for the next 4 weeks highlighted the atrophy in my calf and ankle in general. But after roughly 4 weeks I was able to perform a weak, but relatively normal heel raise with both feet while standing . From there it was a matter of dealing with swelling and making small daily gains very similar to weight lifting. The speed at which I seemed to gain strength back did slow from the first 4 weeks out of the boot, but was finally able to walk and exist as a normal human at the 16 week mark.
Which brings me to current, my next goal is “Return to sport”, which unfortunately still feels a long way off. The literature and doctors all seem to point towards a full year of recovery and therapy/strength training before being able to run and jump without obvious weakness and fear or re-rupture. My current range of motion is almost to full, still dealing with swelling and soreness when standing after sleeping or sitting for an extended period and the initial pushoff from the ground when walking is very weak. To keep on the positive side, I am grateful to be able to walk without crutches or a boot. I can ride a bike, and for the most part my only restrictions are to avoid sudden force on the tendon, so no running or jumping. I will update in a few months on my progress, but so far so good, and all without surgery
