First published in Daily Maverick 168

Springbok flank Pieter-Steph du Toit is used to adversity even more than he is to triumph. This is a man who, at the age of 28, is about to complete a fifth injury-ravaged season out of the last nine.

By the end of 2020, barring six games in Super Rugby earlier in the year, 2019’s best rugby player on the planet won’t see the field again. Between his breakthrough senior year in 2012 to 2019, Du Toit missed four years out of eight because of a brutal catalogue of injuries.

Savage injury catalogue

Of the years in which he has competed, he has earned 55 Test caps, won a World Cup, a Rugby Championship, captained the Springboks, was South African Player of the year three times (2016, 2018, 2019) and World Player of the Year in 2019. It’s a quite remarkable body of work for someone whose own body has suffered more than any person should in a lifetime, let alone eight years.

One prominent physiotherapist likened the effects of a Test match on the body of a player to those of someone in a 60km/h head-on collision. It’s a brutal sport, but even by rugby’s unforgiving standards, Du Toit has suffered more than most.

 Du Toit has had left and right ankle surgery, two knee operations, a cracked sternum and, perhaps most serious of all, acute compartment syndrome, which nearly cost him his left leg earlier this year. For a second time. That’s not even listing the usual rugby ailments of dislocated fingers, muscle tears and general battering.

Acute compartment syndrome is a potentially fatal condition that blocks blood supply from one area of the body to another as a result of an inflamed muscle compartment. Following trauma, the fascia – the connective tissue that keeps the muscle in place – cannot stretch and the resultant swelling causes a disruption in blood flow to nerves, capillaries and muscles.

Du Toit is only the 43rd person in recorded medical history to have suffered this condition. And it’s happened to him twice. He is not only special on the field, it seems.

Thanks to fast-acting Stormers’ team doctor Jason Suter, he will be able to continue his career instead of continuing life with a prosthetic limb after having an emergency fasciotomy.

But the recovery hasn’t gone as smoothly as planned and a third operation was needed earlier this month. But an optimistic Du Toit told DM168: “This time it’s feeling much better. And I feel I am going to be fine now.”

How it happened

In February, after taking two heavy blows on his thigh while playing for the Stormers against the Blues from Auckland, Du Toit hobbled from the field midway through the second half.

He takes up the story: “After the second hit, the contusion was pretty bad and the leg swelled up.

“I still played on for five or 10 minutes and eventually told the medical staff that I couldn’t go on.

“Initially I just went to the side line and had ice strapped around my leg to reduce the swelling. When the final whistle blew I stood up to shake hands with the opposition and I immediately knew something was not right. I could not feel my leg.

“I had suffered a similar injury in 2010 when I was in final year of high school so I said to the doc that we needed to keep an eye on it. He agreed and immediately sent me to hospital for a check-up.

“When I got to the hospital I wasn’t in pain but there was this odd sensation of pressure in the leg – like my thigh wanted to explode. It swelled up because there was nowhere for the blood to go. I didn’t respond to meds and the specialist quickly took me into surgery to relieve pressure and get blood to the lower leg.”

The initial operation saved his leg but the wound was massive. A slice the length of his thigh (about 40cm, Du Toit estimates) was left open for more than a week. The muscle in his thigh was so inflamed that doctors could not pull the skin over the gash to stitch it.

He had a second operation to try to close the wound and still the gaping chasm could not be sealed, leaving the doctors no choice but to put on a vacuum dressing that keeps the wound covered while the swelling reduces.

After 12 days, doctors were able to stitch the wound, but by then Du Toit had lost nearly 10 kilograms, much of it coming from loss of muscle mass in his leg.

“That actually saved me because the loss of muscle allowed the doctors to be able to close the wound. Basically, my leg reduced in size so the skin could stretch over the cut,” he said.

“The vacuum dressing does a job but there is still a very high chance of infection. After the first week they took off the vacuum dressing to clean the wound and when I saw it, I felt faint. Seeing your own muscle bulging out of a gash in your leg is tough,” he added.

“I could only bend my leg about 20 degrees after the operation, so I have had to basically learn to use it again. I’m getting my strength back slowly but my VMO (Vastus Medialis Oblique) muscle almost completely disappeared and I’m working hard to rebuild it.”

Mental toughness

Du Toit is confident that he will be back to his best before the British & Irish Lions tour South Africa in July 2021.

Given his catalogue of injuries, which pale by comparison to his current rehabilitation, what makes him keep coming back for more punishment?

“I guess I’m just dumb enough to never give up,” Du Toit said with a laugh. “I don’t think about injuries, which I think is because I have no other option really. I never think negatively; all I think about is getting fit again.

“I saw Bismarck du Plessis suffer a serious knee injury once and I thought: ‘I never want an injury like that.’

“Two weeks later I suffered the same injury. But I learnt from that experience,” Du Toit says.

“Your brain is a powerful thing and maybe I let negative thoughts creep into my head. That doesn’t happen any more.” DM168