"I really don't know."

Last Thursday I visited my doctor for an 8-month checkup. I thought it was going to be a short, routine visit, but it turned into an all-day event. I spoke to my doctor (and his accompanying fellow) about my minor jogging injury from the previous week and expressed my concerns over my continued pain and lack of strength. Though my doctor was not terribly concerned over the injury or persistent soreness, he was troubled by the appearance of my atrophied calf and the resulting absence of power. He sent me for an MRI of both my lower legs to see what was going on.

mikhaila_markham_mri_2

Four hours and an MRI later, I was back in my doctor’s office waiting for results. He examined the MRI images and explained that he was looking for fatty infiltration into the muscle, atrophy of the calf muscle, and hypertrophy of the Flexor Hallucis Longus (FHL). Fatty tissue growing into the muscle is irreversible and detrimental to muscle recovery, so it was very fortunate that no evidence of that was found in my MRI. Unsurprisingly, the medial head of the gastrocnemius muscle was found to be markedly atrophied.

This made my doctor question what kinds of exercises I've been doing to strengthen my calf. After listing all my exercises (including heel raises, toe walking, jogging, etc.) my doctor told me I was doing precisely what he would suggest. So if I am doing everything I can with a healthy (albeit small) muscle, why is my calf still so atrophied? With all the jogging and jumping I’ve been doing, I would expect to see some greater results.

My doctor explained that while I still have healthy muscle, it’s hard to know what the potential to gain momentum is now that I’m lagging behind at this late stage. This news has been pretty devastating. I feel like the one person who is supposed to know exactly what’s going on has absolutely no idea. It's never good to hear the words "I really don't know," from someone you trust and expect to have answers.

My doctor and his fellow hope that my Achilles and calf simply require a longer recovery time, given that my calf was atrophied even before surgery. However, he also hypothesized that my tendon was not at an optimal resting tension for so long prior to my second surgery that perhaps, despite his surgical efforts, the muscle won’t regenerate.

It seems to me that my doctor is anticipating the latter. During my appointment, he said he was very sad about my lack of power and even apologized--twice. He also mentioned a brace with a hinge and spring that could be inserted into the bottom of my shoe to better propel me during running. These remarks don’t exactly embody confidence.

In the end, my doctor suggested “sitting tight” and waiting to see how my strength is in November at the one-year mark. I was instructed to continue my regular exercises and, if I still lack power at that time, I will have to decide whether or not this is something I want to live with.

If it isn’t, my doctor said I may need to consider another surgery. This is where the FHL comes into play, as my doctor mentioned a procedure that would remove that tendon from its natural location and use it instead to bolster my Achilles. This is not a good option for dancers as it limits the use of the big toe, hindering the point. I don’t even want to consider it.

These latest developments have brought me back to my past concern over the resting tension of my new Achilles. Though my therapist informed me that there is no “normal” resting tension, she also commented that the tension in my good leg is so extreme, it’s bizarre. Maybe a lifetime of Scottish highland dancing contributed to this unusual tension, and perhaps it’s even the reason I ruptured my Achilles in the first place, but if that’s my “normal,” I feel that the surgical side should more closely match. It does not.

I'm not trying to pretend to be a doctor, but I’ve been reading some studies that all attribute optimal resting tension as the key to a successful Achilles tendon repair. My doctor doesn’t seem particularly concerned about this issue, but recent events have left me wanting a second opinion.

While I’m still working hard and continue to look for improvements, I admittedly have very little confidence that this is working. Hopefully everything will work out and this extra long, ranting blog post will just seem silly someday, but this is how I feel right now and I think it’s important to document.