By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.
The gastrocnemius makes up a large portion of the calf muscle. The muscle below it called the soleus completes the large muscle belly in the back of the lower leg. The muscle connects the upper leg bone just behind the knee to the heel bone at the bottom of the foot.
- Overstretching the muscle beyond its elastic limits.
- Foot is moved up excessively when the knee locks during an activity.
- Usually associated with poor calf flexibility.
- Age causes loss of elasticity of muscle fibers.
- More common in men over the age of 35.
- Occurs after the muscle has warmed up and then cooled down for a short period of time. When the muscle is utilized actively again following the cool down phase tears are more common. (Example, second half of a flag football game, second or third set in a tennis match after resting between sets, second half of a basketball game after prolonged sitting during halftime.
SIGNS AND SYMPTOMS:
- Immediate feeling of a pop in the calf muscle.
- May be confused with an Achilles tendon rupture.
- Immediate inability to weightbear on the foot.
- Immediate pain and swelling.
- Swelling and discoloration extend down to the ankle and heel area.
- Difficulty weightbearing is usually present for at least 10-14 days.
- Underlying fracture of the bone must be ruled.
- Identify the extent of injury (partial versus complete tear).
- Ice to minimize the bleeding and swelling in the area, 20 minutes on, 40 minutes off as often as possible for the first 2-3 days.
- Anti-inflammatory medication may benefit in reducing the amount of inflammation. It has been shown to have beneficial effects in soft tissue injuries.
- Compression with an ace bandage or a leg sleeve.
- Utilization of crutches for 7-10 days.
- Physical therapy is usually done after the first few days. Ultrasound, electrical stimulation may help to diminish the amount of swelling and limit the muscle damage. Treatment is then focused on exercising light off weightbearing range of motion exercises to allow contraction of the calf muscle. Over a period of time strengthening consists of both concentric (muscle shortening) and eccentric (muscle lengthening) exercises to promote full strength.
- Slow return to sneakers or shoes with a heel lift after 2-3 weeks.
Prognosis for these injuries is excellent. They never need to be corrected surgically, even in a collegiate or professional athlete. Once the muscle tears, scar tissue usually develops between that region causing some thickening to the area that was torn. Recovery of muscle strength is usually present if the muscle has been mobilized shortly after the injury. A slight deformity also develops in the calf muscle when comparing it to the unaffected side. Full return to all sports activities should be allowed between 3 and 6 months depending on the degree of injury to the area.
Below is a photograph of the back of the calf that is swollen and bruised from tearing of the calf muscle. The muscle has very good blood supply and bleeds significanty when torn causing the extensive brusing and can be very painful.
Pictured below is an MRI of the calf muscle that is torn. When compared to the other leg, also in the picture, the tear in the muscle can be seen as a white color due to the inflammation in the area and highlighted by the red arrows.