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INTRODUCTION

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Kompany remains sidelined with a calf injury, sustained after just seven minutes of City’s goalless draw with Dynamo Kiev one month ago. Remarkably, it is the 14th time he has suffered a problem with his calf since joining the club in 2008—with five of them occurring this season—and his 32nd injury overall during the past eight years.

PhysioRoom, 12 April 2016

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Calf pain is common and if not managed appropriately it can persist for months and cause frustration for both athlete and clinician. Both acute and chronic calf pain can stem from injury to the calf muscle.

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ANATOMY

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The anatomy of the posterior compartment of the leg (Fig. 39.1) will be covered here. The anterior and lateral aspects have been covered in Chapter 38.

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Figure 39.1

Anatomy of the calf (a) Surface anatomy (b) Superficial calf muscles (c) Removal of the gastrocnemius showing the underlying soleus and plantaris muscles (d) The intramuscular tendinous structures within the soleus muscle

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The muscles in the posterior compartment of the leg comprise a superficial and deep group. The superficial group is composed of the triceps surae (gastrocnemius and soleus) and plantaris muscle. These form the bulk of the calf muscle. The deep group is composed of the tibialis posterior, flexor digitorum longus, flexor hallucis longus and popliteus muscles.

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Gastrocnemius has two heads; the medial and larger head is attached to the posterior aspect of the medial epicondyle of the femur and the lateral head to the lateral femoral condyle (Fig. 39.1b) The muscle extends down to the mid-calf, following which it inserts into a broad aponeurosis which receives the tendon of the soleus to form the tendon of Achilles (TA). The two heads are overlaid by the tendon of biceps femoris and the common peroneal nerve laterally and the semimembranosus muscle medially. This latter area between the medial head and semimembranosus is the location of the ‘Baker’s cyst’ (Chapter 37).

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Soleus is a large flat broad muscle, deep to the gastrocnemius (Fig. 39.1c). It arises from a number of locations; the posterior aspect of the head and proximal shaft of the fibula, the soleal line (prominent ridge posterior tibia), medial aspect of the tibia and a fibrous band between the tibia and fibula. The muscle joins with the tendon of gastrocnemius and together they form the TA, inserting into the calcaneal tuberosity.

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Both the gastrocnemius and soleus muscles in the calf have been noted to have intramuscular tendons. In the gastrocnemius muscle, separate proximal medial and lateral tendons arise from the posterior aspects of the medial and lateral femoral condyles respectively.

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There are three tendinous structures within the soleus muscle—medial and lateral ‘aponeuroses’ proximally, and a ...

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