History
See the list below:
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An audible pop when the injury to the medial calf occurred is usually reported, and the patient complains of feeling like a stick struck his/her calf.
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The patient complains of pain in the area of the calf, which also radiates to the knee or the ankle. In addition, the patient complains of pain with range of motion (ROM) of the ankle.
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The patient complains of a swollen leg that extends down to the foot or ankle, as well as the associated color changes of bruising. (See also the Medscape Reference article Contusions.)
Physical
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Inspection
Asymmetric calf swelling and discoloration, potentially spreading to the ankle and foot, is noted on physical examination.
If the stage of swelling has resolved, a visible defect in the medial gastrocnemius muscle may be evident.
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Palpation
Tenderness is noted upon palpation in the entire medial gastrocnemius muscle, but this tenderness is observed to be exquisitely more painful at the medial musculotendinous junction.
Depending on the degree of swelling, a palpable defect may be evident at the medial musculotendinous junction; however, with extreme swelling, this finding may not be appreciable.
Palpation of the Achilles tendon should demonstrate an intact tendon.
The peripheral pulses should be present and symmetric.
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Provocative maneuvers: Moderate to severe pain is demonstrated with passive ankle dorsiflexion (due to stretching of the torn muscle fibers), as well as with active resistance to ankle plantar flexion (due to the firing of the torn muscle fibers).
Causes
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Age/activity status: As indicated in the Background section, medial calf injuries occur more commonly in the middle-aged recreational athlete. This population typically continues to be physically active at a moderate to high intensity but not on a regular basis, and these individuals are also likely to have maintained a moderate degree of the muscle mass from their more active days. Yet weekend warriors seem to have started to lose some of the flexibility they had when they were younger, resulting in a relatively large gastrocnemius muscle that is less flexible than it had been, and on occasion, the muscle is challenged with a ballistic or explosive force, leading to a partial or complete rupture.
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Deconditioned/unstretched muscles: The cold and unstretched muscles that recreational athletes often use to compete with are very likely to rupture when challenged compared with conditioned and stretched muscles. However, because medial calf injuries also occur in the physically fit, the role of stretching in prevention is not completely understood. This phenomenon may mean that force versus elasticity is the key formula, and if the force overcomes the elasticity, even in a conditioned athlete, then a rupture or injury can occur.
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Previous injury: The athlete with recurrent calf strains is likely to have healed with fibrotic scar tissue, which absorbs forces differently and is thus more likely to result in rupture when the muscle is challenged.
