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Introduction

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First it was frustrating, then it got beyond frustrating. It was very hard. In the past, I’ve never dealt with any injuries before. To sit out the whole season is very frustrating for a player.

Sheryl Scanlan, New Zealand Silver Fern and world champion netball player who was stunned by a major calf strain in 2009 and then injured the same muscle in the other leg in 2010

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Calf pain is a common presenting complaint and, if not managed appropriately, it can persist for months or recur and cause frustration for both sportsperson and clinician. Both acute and chronic calf pain can stem from injury to the calf muscle.

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The term “calf muscle” refers to the triceps surae, which includes the gastrocnemius, the soleus, and the plantaris muscles. The more superficial muscle—the gastrocnemius—has medial and lateral heads that arise from the femoral condyles, whereas the deeper soleus arises from the upper fibula and the medial tibial border. The plantaris muscle arises just medial to the lateral head of the gastrocnemius and crosses the popliteal fossa.

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These muscles have a joint tendon, the Achilles, which inserts onto the calcaneus. Together they act as a venous pump for the lower limb. Injuries to the Achilles tendon are discussed in Chapter 37. As a biarthrodial muscle extending over the knee and the ankle, the gastrocnemius is more susceptible to injury than a uniarthrodial muscle. The anatomy of the calf is shown in Figure 36.1).

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Figure 36.1

Anatomy of the calf

(a) Surface anatomy

Graphic Jump Location
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(c) Removal of the gastrocnemius showing the underlying soleus and plantaris muscles

Graphic Jump Location
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Clinical perspective

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Injuries to the musculotendinous complex are by far the most common causes of calf pain. Muscle strains occur most commonly in the medial head of the gastrocnemius, or near the musculotendinous junction. Acute calf muscle strains are common among middle-aged sportspeople, particularly in racquet sports.

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An MRI study of calf injuries reported that gastrocnemius strains accompanied by other muscle strains may be more common than previously thought.1 Other muscle strains included strains of soleus, plantaris, tibialis posterior, flexor hallucis longus, and flexor digitorum longus. This highlights the importance of a thorough examination, as the presence of associated strains will change treatment and prognosis.

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A sudden burst of acceleration (such as stretching to play a ball in squash or tennis) may precipitate a calf injury. The calf region is also a common site of contusion caused through contact with playing equipment or another player. Muscle strains and contusions are acute injuries that ...

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