Anatomy of Calf Muscles
Calf injuries frequently involve the Soleus, Popliteal, Gastrocnemius, and Plantaris muscles. The gastrocnemius is the bulkiest muscle, with two heads (lateral and medial) originating from the femur and inserting into the calcaneus via the Achilles tendon. Together with the Soleus, they form the Triceps Surae, which is essential for walking, running, and jumping. The gastrocnemius is the primary flexor of the ankle and is supplied by the tibial nerve and posterior tibial artery (1, 2).
The Soleus lies beneath the gastrocnemius and is composed mainly of slow-twitch fibers for endurance. The Plantaris, found between the two heads of the gastrocnemius, assists in knee flexion and plantar flexion (3, 4).
What Causes a Calf Muscle Tear?
Calf muscle tears are often caused by a sudden, unbalanced force, such as jumping or a rapid push-off, which shifts the ankle from plantarflexion to dorsiflexion. This is common in tennis players (known as “tennis leg”) and typically involves the medial gastrocnemius muscle (5).
Symptoms
Common symptoms include:
- Sudden tearing sensation, sometimes with a “pop” sound
- Sharp, sudden pain in the calf
- Difficulty bearing weight on the affected leg
- Improvement when walking on toes; increased pain with dorsiflexion or plantar flexion
- Swelling, redness, and bruising
- Muscle tenderness and weakness
These symptoms often follow a sudden jumping or sprinting movement (6).
How is Calf Muscle Tear Diagnosed?
Diagnosis starts with a history and physical exam. The affected area may show swelling, redness, and ecchymosis. The muscle is usually very tender, and a palpable defect may be present. The Thompson squeeze test can help rule out Achilles tendon rupture (it is negative in calf muscle tear). Imaging such as MRI or ultrasound may be used to assess the severity and monitor recovery (7).
Treatment
The RICE method is the first-line treatment:
- Rest: Avoid physical activity; use boots or crutches if needed.
- Ice: Apply ice packs every two hours for 20 minutes to reduce swelling.
- Compression: Use a wrap or sleeve to reduce swelling and support the muscle.
- Elevation: Keep the leg above heart level to minimize swelling (8).
Precautions during healing:
- Avoid heat application
- Avoid weight-bearing or pressure on the calf
- Avoid physical activity until cleared by your provider
Physical Therapy
After initial healing, physiotherapy helps restore strength and function, prevent re-injury, and guide safe stretching and strengthening. Over-the-counter painkillers like ibuprofen may be used for pain relief. Follow your physiotherapist’s guidance and avoid overstretching or weight-bearing activities too soon.
Calf Muscle Tear Surgery
Surgery is reserved for severe cases not responding to RICE and physiotherapy, especially in athletes or those with complete tears, swelling, and internal bleeding (9).
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat calf muscle tears. Published research has proven its pain-relieving, anti-inflammatory, and regenerative benefits. Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help calf muscle tears. As prolotherapy is helping to treat the root cause of calf muscle tears, it is deemed to be a permanent fix, preventing the symptoms from returning.
Complications of Calf Muscle Tears
Complications are rare but may include compartment syndrome, superficial thrombophlebitis, and deep vein thrombosis (DVT). Compartment syndrome involves severe swelling, while DVT and thrombophlebitis involve blood clots (10).
Prevention
To prevent calf muscle tears:
- Take rest between strenuous activities
- Perform regular strengthening and stretching exercises
- Follow expert instruction for sports and gym exercises
- Warm up before activity
- Use supportive footwear, especially during sports
- Stay hydrated and avoid sudden increases in activity
- Understand calf strain symptoms and treatment for early intervention
Regular check-ups can help identify underlying issues that may predispose you to injury.
Frequently Asked Questions
What happens if your calf muscle pops?
A popping sound may indicate a strained or pulled gastrocnemius muscle. This is followed by sharp pain, difficulty standing, and possibly bruising if the strain is severe.
Can you walk with a torn calf?
Walking is difficult and painful with a torn calf muscle. Swelling and pain often require rest and sometimes assistive devices.
What is the difference between a calf strain and a tear?
Strains cause tightness, weakness, and tenderness. Tears cause sudden pain, a popping sensation, swelling, and limited motion. Tears may be partial or complete.
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating calf muscle tear, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with calf muscle tear and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
References
- Park, K. B., et al. (2019). The architecture of the Triceps Surae Muscles Complex in Patients with Spastic Hemiplegia. J Clin Med, 8(12), 2096. https://doi.org/10.3390/jcm8122096
- Rodrigues, V., Rao, M. K., & Nayak, S. (2016). Multiple Heads of Gastrocnemius with Bipennate Fiber Arrangement. J Clin Diagn Res, 10(8), AD01–AD2. https://doi.org/10.7860/JCDR/2016/20094.8340
- Gallo, R. A., et al. (2012). Common leg injuries of long-distance runners. Sports Health, 4(6), 485–495. https://doi.org/10.1177/1941738112445871
- Campbell J. T. (2009). Posterior calf injury. Foot Ankle Clin, 14(4), 761–771. https://doi.org/10.1016/j.fcl.2009.07.005
- Millar A. P. (1979). Strains of the posterior calf musculature (“tennis leg”). Am J Sports Med, 7(3), 172–174. https://doi.org/10.1177/036354657900700306
- Delgado, G. J., et al. (2002). Tennis leg: clinical US study of 141 patients. Radiology, 224(1), 112–119. https://doi.org/10.1148/radiol.2241011067
- Kwak, H. S., et al. (2006). Ruptures of the medial head of the Gastrocnemius (“tennis leg”): clinical outcome and compression effect. Clin Imaging, 30(1), 48–53. https://doi.org/10.1016/j.clinimag.2005.07.004
- van den Bekerom MP, et al. (2012). What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train, 47(4), 435-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/
- Cheng Y, et al. (2012). Surgical treatment of gastrocnemius muscle ruptures. Orthop Surg, 4(4), 253-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583476/
- Coffey R, Khan YS. Gastrocnemius Rupture. [Updated 2022 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK560869/