Re-rupture?

I had my first follow-up appointment on Monday, November 24th. I was looking forward to the appointment not only because it gave me the opportunity to clear up some questions, but also because it meant the removal of the oversized dressing that encased my leg. I called it “The Mummy” and was not at all sorry to see it dismembered.

new_boot

My doctor began the appointment by explaining what happened during my surgery. He described the condition of my old Achilles tendon and drew a picture of what it looked like, demonstrating why an allograft was necessary. It was a much more detailed account than my parents received in the waiting room ten days previously. 

He was certain my tendon had re-ruptured at some point during my first recovery. Because it went untreated, the separated pieces of my tendon grew further and further apart as I continued using it, unrestricted in my movements. Scar tissue formed in its place. Combined with the other tendons and muscles in my leg, the scar tissue provided just enough of a connection between my calf muscle and heel to give me 70% of my former strength.

My doctor’s artistic skills were stylized much like his signature, so I sketched it out myself for just a little more clarity.

achilles_sketch.jpg

Though it was unexpected, I was not incredibly surprised to learn that I had re-ruptured my Achilles tendon. In fact, I could pinpoint the exact date it happened. In late August of 2013, nearly four months after my first surgery, I injured my healing tendon just ten minutes after arriving at the beach in Ocean City. At the time, I didn’t want to consider the possibility that it had re-ruptured. My ankle swelled up immediately and turned a lovely shade of blue, but I was still able to walk, though it was painful for a few days. I also didn’t notice any sign of a gap in my tendon, yet the division had been visible after my initial rupture. When I visited my former doctor (let’s called him Dr. B) two days later, he speculated that I simply “tore some fibers” and called the injury “mild” in his report.

At that appointment, Dr. B performed a Thompson test, which is used to determine if the Achilles tendon is still intact. To execute this, the patient lies prone with the knees flexed at a 90 degree angle. The examiner then squeezes the calf muscle, at which point plantar flexion (pointing the toe) should occur. This demonstrates that the Achilles is still connected. The test is positive—and indicative of a rupture—if the foot remains in the neutral position or moves only slightly in comparison to the unaffected side. At the time of my injury, Dr. B reported a negative Thompson test, concluding that my Achilles was still intact and that I just needed a few days rest. While my injured foot did plantar flex slightly during the Thompson test, Dr. B. did not compare the movement to that of my right, unaffected side. Had he done so, he would have noticed that there was a significant difference in the range of motion. This oversight probably cost me an entire year of dancing. I’m trying not to be bitter.

achilles_scar

Monday's appointment was not all bad news. Once my doctor finished explaining my surgery, he checked the integrity of my new tendon by performing the Thompson test. When my calf was squeezed, my foot moved ever so slightly! My doctor said it looked very promising.

After the examination I was fitted for a new walking boot. It has three wedges in the heel to keep my foot in a plantar flexed position. Beginning next Monday, December 1st, I’ll be able to start touching my foot down while I walk with crutches. Though I won’t be able to put more than 50% of my bodyweight down, it is more than I expected. My stitches will also be removed at that time. There are about twenty-six of them on the outside alone and my scar is a little over eight inches long. I’m not really bothered by scars though. There’s hardly any pigmentation in my skin anyway, so it’ll fade right back to pasty white soon enough. So long as it does the job, I’m happy.