There is truth in the view that doctors make the worst patients. I have never seen a person obstruct their own recovery more than a surgical consultant who snapped his achilles tendon while playing tennis.
The achilles is a ropelike band of tissue, which connects the calf muscle to the heel on each side, and is crucial for walking, running and jumping. With time and disuse, the tendon can become weak and prone to rupture. So it's no surprise that injuries to this part of the body tend to occur in middle-aged men enjoying a spurt of uncharacteristic activity, especially where leaping and pivoting are involved. Tripping or falling from a height are also mechanisms of injury.
When it ruptures, sufferers feel sudden severe pain in the ankle or calf, and may hear an audible "pop". Diagnosis in an emergency department is usually made by a doctor asking their patient to lie prone, feet dangling off the end of the examining table. On squeezing the calf muscle, an intact achilles will cause the foot to point – the absence of this reaction suggests a rupture. Although competitive athletes may be put forward for surgical repair of their tendons, most patients have their leg immobilised in a cast for at least six weeks.
Far worse than this, though, are fractures to the heel bone (or calcaneum). Such injuries tend to occur after a fall from a height or from severe twisting of the foot, and are known to be so painful that patients may be distracted from other injuries such as spinal or leg fractures, which often occur at the same time. Whether patients have surgery or not, it is usually not possible to start walking for at least three months after breaking your heel, and the incidence of lifelong disablility from chronic heel pain is high.
But after five weeks in a cast for his achilles tendon rupture, my boss decided he simply couldn't bear to be hampered a day longer. He pulled off his own cast, and sprung out of the door, ready for another day at the hospital. He didn't get as far as his car before he had ruptured his tendon all over again. Proving impatience is the surgeon's true achilles heel.
Gabriel Weston is a surgeon and author of Direct Red: A Surgeon's Story.
