Calf injuries not involving the Achilles tendon
- Catherine Rogers Rainbow, MD, SMCAQ
Catherine Rogers Rainbow, MD, SMCAQ
- Clinical Instructor
- University of North Carolina School of Medicine
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Section Editor
- Peter Fricker, MBBS, FACSP
Peter Fricker, MBBS, FACSP
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Exercise, Sports Nutrition, and Miscellaneous; Sports-Related Injuries
- Adjunct Professor
- Griffith University
- Institute of Sport, Exercise, and Active Living
- Victoria University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Posterior calf injuries are common and occur in both competitive and recreational athletes, and active laborers. The major posterior calf muscles include the gastrocnemius, soleus, popliteal, and plantaris muscles. These muscles primarily perform active plantarflexion of the ankle and are typically injured during ballistic movements. Patients with posterior calf injuries present with limping, swelling of the posterior calf, and significant pain at the time of injury.
This topic will review common and important posterior calf injuries, including the mechanisms of injury, diagnosis, and management. Achilles tendon and other leg injuries are discussed separately. (See "Achilles tendinopathy and tendon rupture" and "Ankle sprain" and "Overview of ankle fractures in adults".)
EPIDEMIOLOGY AND RISK FACTORS
Muscle strains of the posterior calf affect both competitive and recreational athletes, but occur most often in poorly-conditioned male athletes in the fourth to sixth decade of life [1-3]. Calf injuries typically occur during sudden ballistic movements involving the lower extremity, such as sprinting or jumping, in sports where these movements are common, such as tennis, football (soccer), basketball, American football, and running on hills . The medial head of the gastrocnemius in particular plays a major role in generating power when athletes jump or sprint, and injuries of the medial head are relatively common. Calf muscle strains usually occur when the muscles are not warmed up properly or have fatigued significantly during exercise. Approximately 20 percent of patients report prodromal symptoms including soreness or tightness in their calf muscle prior to the injury .
Competitive male masters runners, defined as older than age 40, are at higher risk for calf injuries. Survey studies from races reveal that calf injury is among the most common injuries for all male runners and disproportionately affects older runners [4,5]. Calf injuries are also common among tennis players . A case series of medial calf injury in 720 athletes found that 16 percent arose from tennis . A large proportion of such injuries occur at the musculoskeletal junction of the medial head of the gastrocnemius muscle or the aponeurosis between the medial head of the gastrocnemius and soleus muscles . These injuries are often referred to as "tennis leg". For patients diagnosed with "tennis leg" only 14 percent of injuries occur at the lateral head of the gastrocnemius , and 1.4 percent involve plantaris rupture .
The literature pertaining to other risk factors for calf injury is limited. A history of a posterior calf strain is a risk factor for recurrent injury [9,10]. Among older soccer players, a history of a lumbar entrapment of the fifth lumbar (L5) nerve root has been associated with an increased risk for posterior gastrocnemius strain, and this condition may be a risk factor for other active adults .
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- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL ANATOMY AND BIOMECHANICS
- MECHANISM OF INJURY AND CLINICAL PRESENTATION
- Gastrocnemius strain
- Plantaris strain and tendon injury
- Soleus strain
- Popliteus tendinopathy
- Popliteal artery entrapment
- DIAGNOSTIC IMAGING
- Musculoskeletal injury
- - Plain radiographs
- - Ultrasound
- - Advanced imaging
- Neurovascular injury
- INDICATIONS FOR SURGICAL CONSULT OR REFERRAL
- DIFFERENTIAL DIAGNOSIS
- Initial assessment and treatment
- Severe gastrocnemius strain
- Non-severe gastrocnemius injury, and plantaris and soleus injuries
- Popliteal tendinopathy
- Popliteal artery entrapment
- RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS