Thursday 16th February 1989   Morning surgery 10:20

My Dad was pretty pleased with himself today. He diagnosed a ruptured Achilles tendon. To top it all, they had missed it in casualty. They thought the patient had a sprained ankle. The man had only come in for a sick note but he said his ankle was still quite painful. He had been walking across the road when it happened. He felt something snap: in fact, he heard it.
My Dad turned to Zoe, Chloe and me. “I think that we better check this chap’s Achilles tendon. An Achilles rupture is a frequently missed diagnosis.”
He made the patient get up on the couch and lie down on his tummy with his feet hanging over the end. “The Achilles tendon runs from the back of the heel up into the calf muscle. It is the strongest tendon in the body.”
My Dad felt very carefully along the length of the tendon. About two inches above the heel, there was a dent that you could fit the tip of your finger in. “There,” said my Dad. “That’s where it is torn.” He made us all feel the tendon. “Now,” he continued, “we will confirm the diagnosis.”
He squeezed the man’s calf firmly to make his foot move upwards. Hardly anything happened. He compared it with the other side. There was quite a big difference.
“Well,” he said. “You will have to go back to casualty, I am afraid. This is definitely a ruptured Achilles tendon. I will write a letter for you to take with you.”

My Dad usually hated writing letters but I could see how much he enjoyed this one. He signed it with a real flourish. He handed it to the patient and gave him a congratulatory slap on the back as if they were a successful team who had got one up on the emergency department.

A ruptured achilles tendon.
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