What’s Afoot?

If you read my post asking (and answering) What’s Up, Doc?, you might now also be asking, “What’s Afoot?”

Here’s an update, along with a few, somewhat interesting, side issues.

Quick background first: I ruptured my Achilles tendon on December 10 while playing tennis. It felt like my shoe had fallen off my foot and that I had then tripped on it. Except that I was barefoot. The Emergency Room took some X-rays, diagnosed the Achilles tendon (which I had already figured out), and then put my lower leg into a splint until it could be seen by an Orthopedic Surgeon.

I saw the Orthopedic Surgeon last Friday (December 15). He’s well-accomplished and has quite a few published papers to his name. He started by saying, “Playing tennis barefoot, eh?” Oh, I’d told the Emergency Room physician and he’d read the report. I let the surgeon know I’d been playing barefoot for 15 years.

I always feel defensive about an injury because of being barefooted—but you’d think that if the bare feet were really the problem, it would have taken a lot less than 15 years to show up. Right? And it’s not as if people who play tennis with shoes don’t get ruptured Achilles tendons. As my surgeon says in the introduction to one of his papers, “The Achilles tendon is among the most commonly injured tendons in the human body.”

He also said they see the rupture most often in 30- to 50-year-old men (sports!). In addition, though, they’re starting to see more in 12- to 18-year-olds (kids in sports being overtrained) and in the 60- to 70-year-old crowd (older folks staying active longer). I guess I shouldn’t have kept playing tennis as aggressively as if I were just a mere 50.

Achilles tendon ruptures are really icky (to use the medical term, heh). It tears right across and then the two ends are separated by between 2 and 6 cm. Here’s a picture you’re sure to enjoy:

A Ruptured Achilles Tendon

[Picture from Surgical Considerations for the Neglected or Chronic Achilles Tendon Rupture: A Combined Technique for Reconstruction.]

So that’s what the interior of the back of my leg looks like right now, more or less. (In that picture, the gap is 5 cm.)

The surgeon looked at my sole and then said, “You have some metal filings in your sole.” That didn’t really concern me. I replied, “Oh, they’re probably just in the thick epidermis and will wear themselves out.” He wasn’t so sure about that. Was he thinking they’d work themselves further in?

And I was wondering if they were really that visible.

Well, I got a copy of my X-rays and the radiologists report, so I know how he found out about the “metal filings”.

Here’s what the radiologist’s report said:

Soft tissue injury at the lateral aspect of the foot with multiple tiny radiopaque densities. Additional small amount of radiopaque debris within the soft tissues overlying the 5th metatarsal head.

In case you are wondering, “radiopaque” means opaque to X-rays. Here’s one of the X-ray views of my heel area.

Such a Heel

See those little specks in the skin (callus) near the front of my heel? Radiopaque. Who knows what’s there; not me.

And you can see the “additional small amount of radiopaque debris within the soft tissues overlying the 5th metatarsal head” here.

Radiopaque

To orient you, the 5th metatarsal is the one that leads to the little toe, so it’s on the outside. The part near your heel is the “base” and the one nearer your toes is the “head”. And if you look at your own foot, that’s the outer edge of the ball of the foot, another area that builds up a fair bit of callus. So it is not surprising that that area might also have picked up some debris.

By the way, these don’t worry me at all. Our barefoot ancestors undoubtedly got all sorts of debris of various sorts embedded in the thick skin of their soles. The body knows how to deal with them.

Actually, I may not have to wonder or care about any of the debris. From what I’ve heard from other barefooters, having my foot in a cast as long as I’m about to, all that well-deserved callus is just going to peel right off from disuse.

Here’s some more of what the radiologists report said:

Avulsion-type fracture at the base of the 5th metatarsal. No other acute fracture or subluxation identified of the foot. The tarsometatarsal joints appear well aligned.

The ankle mortise is symmetric and intact. Mild calcaneal spurring is noted. There is otherwise no definite acute fracture or subluxation of the ankle.

Here’s another X-ray from a different angle to discuss that.

Avulsion Revulsion

The red arrow continues to mark the specks at the front of my heel. From this angle we can see that it’s right near the outer surface of my callus.

The purple arrow looks like a small piece of wire? But from the two perspectives, it appears to again be near the outer surface of my skin (but more on the side and up my sole a bit).

The blue arrow marks the “avulsion-type fracture”. I’ve torn off a small part of the base of the 5th metatarsal. An “avulsion-type fracture” is one in which the tendon attached to the bone at that point actually tugs so hard that it breaks the bone and pulls it away. I wonder if this could have occurred as part of the Achilles tendon rupture or as I fell (or maybe it’s been there a long time). The surgeon didn’t think anything had to be done about this.

Something else that I find interesting looking at that X-ray is that we can see just how thick my callus is. Measuring it (the X-ray program came with a handy-dandy measuring tool), it’s between 6 and 8 mm in thickness. That’s some pretty good padding. You can also see that the fat padding under my heel looks pretty healthy. My guess there is that all the increased blood flow from walking on it barefoot really helps in that regard. And the “mild calcaneal spurring” (heel spurs) cause no problem for me at all because everything else is thick and healthy.

My surgery is scheduled for Thursday, December 21. I’ll be arriving at the surgical center right at the Solstice. The surgeon mentioned that sometimes they have to steal tendons from other areas to help reconnect the Achilles. He even mentioned one of the tendons that goes to the big toe. I sure hope he’s not planning on doing that to me—I use my toes way more than a shod person (and don’t wear toe-supporting and weakening shoes, either).

We’ll see how it goes. I imagine I’ll be coming out of there with a pretty impressive scar on the back of my leg (not that I’ll be able to see it until the cast comes off).

After it heals (which I expect will take longer for me than for a younger person) it’ll be off to rehab and physical therapy. I’m hoping a lot of hiking is on that agenda.