A white sand beach in Sierra Leone, West Africa.
"Come on, I'll race you." It was raining. We were hurrying back along the beach. I was sprinting along the wet sand, feeling the wind, the rain, the exhilaration. Then, without warning, I hit the ground. Hard. And without even a split second warning to try to break my own fall. I thought I must have tripped, but behind me was nothing but an expanse of sand. My right foot felt weak. I tried to stand up and fell over. A memory flashed into my mind of a friend who had injured herself playing tennis. I remembered her description of falling over out of nowhere. I put my hand to the back of my foot just above the heel.
"I think I've broken my Achilles tendon," I said. Where once there was a taut tendon attaching my calf muscle to my heel bone, there was nothing more than a loose flap of skin. My companion helped me to sit upright. I felt horribly unwell. I put my head between my knees. Then I looked up at him briefly: 'I think I'm going to,' I said. And passed out.
It was the first week of July. I was on Tokeh Beach, a stunning white sand beach in Sierra Leone, West Africa. We were over an hour from the capital by four-wheel drive. Three hundred yards of beach, a tidal river, sinking sands and rocks separated us from our vehicle. Even once we reached Freetown, health care in this, one of the poorest countries in the world, was basic in the extreme.
That day I had two pieces of good fortune. The first was that I was with somebody who, waving away my faintly delirious offers to crawl, picked me up bodily and carried me virtually the entire distance. The second was that the closest medical centre was the War Victims and Amputees Hospital, staffed by Italian medics and orthopaedic specialists. There they confirmed my suspicions: my Achilles tendon had broken. The Achilles tendon is the largest and most powerful tendon in the body. It serves as the power source for pushing off the foot. It is what enables basketball players to leap four foot off the ground, dancers to soar, sprinters to explode away from the starting blocks.
Achilles, the son of a king and a sea nymph, was the greatest warrior of the army of Agamemnon in the Trojan War. As a baby, his mother dipped him into the waters of the River Styx, making him invulnerable, except for the heel by which she held him. He was ultimately slain in battle by an arrow to the back of the heel. It is perhaps the most aptly named body part.
The Achilles tendon, strong enough to pull a truck, is also curiously fragile, prone to rupturing if placed under sudden or unexpected stress, usually with a crack like a gunshot. It happens so fast that athletes injured in that way are convinced they have been tripped or hit. Afterwards, unless it is treated, you cannot run or jump. You can barely walk.
Vittorio, the chief nurse, told me my injury should ideally be treated within 48 hours. After that time the tendon slowly begins to retract up the calf. I would almost certainly need an operation. They offered to operate, but we agreed I would be better recuperating at home. They fitted me up with a partial plaster to support my foot and a pair of crutches, which I promised to return as soon as I could.
It was another five days before I could be flown home. Curiously, I was barely in any pain. I spent the time getting used to my crutches and to the kindness of strangers. In a country of war amputees, it was remarkable how much sympathy could still be summoned for a woman who injured herself running along a beach in a bikini. 'Hush you,' murmured even smallest children as I hobbled by.
Straight from the plane via an ambulance organised by my travel insurance company to the A&E department of King's College Hospital. 'Classic age. Classic injury,' said the orthopaedic consultant. 'It's usually a 40-year-old man playing squash, but I'm seeing more and more women these days.' Running on wet sand is apparently a common cause of an Achilles trauma. The sand gives way under the heel, the tendon is overstretched and snaps.
He asked me to lie on my stomach and squeeze my calf: the Thompson test. When the muscle is squeezed, the foot should move. If it doesn't, that is an indication that the tendon is almost certainly broken. I was admitted and wheeled up to the ward, my operation scheduled for the next day. In the event, the operation was postponed several times. On the third day, I was wheeled into the theatre.
In the standard procedure, the back of the leg is sliced open and the two ends of the tendon stitched together. But a newer version, which was performed on me, involves making several small incisions and results in fewer scars.
I woke up with my leg and foot immobilised in a heavy plaster in a balletic point. My cast will be changed for a lighter one in two weeks' time, and then again every fortnight as my foot is gradually moved back into a 90-degree angle. With that, I was discharged.
Back home I searched the internet for information, ghoulishly watching a video of the procedure I had just undergone. I ordered supplies of calcium and magnesium; glucosamine sulphate, which helps with the healthy maintenance of joints; L-Arginine and L-Ornithine, said to stimulate muscle growth and repair. Then I settled down in front of the TV and brand new DVD player. Once the cast is removed, I will need two to three months of physiotherapy. A full recovery is six to nine months away.