Achilles Rupture Recovery

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The MRI visit was initially problematical, because the three young ladies performing the MRI were trying to insist that I had to put my foot into the ‘neutral’ position … for me, it was bad enough taking off the boot (my brain screaming, “DANGER! DANGER!”) nevermind going from 30 degrees (Ed: it’s called ‘plantar flexion‘, like a ballet dancer) to zero. My brain said no; the pain said, “NOOOO!”. With getting on for 10 mins of inching this way and that, we found a handleable kind of compromise 20-ish degree position allowing them to mount the coils relatively tightly around the ankle/foot necessary to get a good magnetic signal to ensure picture quality was ok … and it worked fine.

A short while later, the MRI team gave me a letter with access codes so that one could download / view the image series. Then it was off back to the clinic in Munich, presenting myself via the walk-in ER for a third doctor to look at me, as instructed the day before. As I took off the shoe, the stink hit me … badly 🤮 . Disgusting and embarassing. Still, the doc said, par for the course with it on 24/7; it hadn’t helped going from a climbing shoe after a 2 hour session directly into the boot without a shower!

A thorough exam including yet another ultrasound followed; we talked, then he consulted the senior foot surgeon and she gave me the green light for a non-operative treatment (which I’d been hoping for). In fact, my tear was relatively high up, I was told (about 9cm from ‘insertion’ at the heel, close to the muscle), meaning an op would be more complicated than a ‘simple’ tendon-to-tendon thing towards the centre of the tendon with a ‘minimal invasive’ op being out of the question -> they would have to really cut me open -> ‘the scales’ swung further in favour of non-operative treatment.

This was also encouraging: I had googled enough to know the trend over the last 10-20 years has been increasingly (albeit slowly) towards non-operative treatment, also with complete ruptures; with healing times as well as functional outcomes being comparable, but obviously none of the infection / other complication risks associated with surgery, I was hoping for this diagnosis (more details to this stuff later … but it is amazing how many cases there are where even gaps of 3cm are bridged by the body to lead to return of full functionality; note: good / consistent physio is super important!).

Note: this is NOT to say I am against operative treatment … if at least 2 doctors had given me – independently – the advice to have my injury operated on, with a solid basis, I would have gone down that path.

What I was also given was a written report and (unfortunately a non-VACOped specific) rehab protocol: I should be 10kg weight bearing from the start once in the shoe; this should be ramped up, depending upon subjective pain (WBAT = Weight Bearing As Tolerated, i.e. not pushing beyond about 2/10 pain, certainly no sharp or lasting pains). The target should be getting up to 100% whilst using the crutches for a minimum of 4 weeks but a maximum of 6 weeks; after this time, at the latest, I should be walking unaided in the shoe.

This was certainly good news for my hands – they were in pain due to supporting 100% of my weight for about 50% of my walking time (I had no instructions to remain bed-ridden and had zero desire nor saw any reason to do so); this pain had actually become, very quickly, my biggest immediate problem, leading to motor problems in my right hand (using a mouse / typing related to my index and middle fingers); in addition, walking with crutches suddenly became much easier and more stabile with me now ‘feathering’ my toes of the injured foot on the ground.

Later at home I went through the MRI pics on my laptop: below, red is the tear, orange is a somewhat damaged section … unlikely to have happened at the same time, I was told; possibly tendinopathy from the past … which led to some speculation that the tear might have occurred due to previous damage. Initially, though, either way: torn is torn!

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< I’m going to come back and do a better job on the collation of prioritised lists later, but for the moment, have a look at this ‘gear’ page I wrote early on > … it’s not great, not complete, and there are some more lists on Reddit, but perhaps better than nothing.

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