The patient will come in limping, having suffered a whip-like sting in his calf while stepping off hard on his foot
or charging the net during a game of tennis, or similar
activity. He may have actually heard or felt a "snap" at the
time of injury. The deep calf pain persists and may be
accompanied by mild swelling and ecchymosis. Neurovascular
function will be intact.
What to do:
Rule out an Achilles tendon rupture. Test for strength in
plantar flexion (can the patient walk on his toes?). Squeeze
the Achilles tendon and palpate for a tender deformity that
repre sents a torn segment. If pain does not allow active
plantar flexion, squeeze the gastrocnemius muscle with the
patient kneeling on a chair and look for the normal plantar
flexion of the foot. This will be absent with a complete
Achilles tendon tear. With any Achilles tendon tear,
orthopedic consultation is necessary.
When an Achilles tendon rupture has been ruled out,
provide the patient with elastic support (e.g., ACE, TEDs
stocking, Tibigrip) from foot to tibial tuberosity.
Provide the patient with crutches for several days.
Permit weight bearing only as comfort allows.
Have the patient keep the leg elevated and at rest for
the next 24-48 hours, initially applying cold packs, and
after 24 hour alternately with heat every few hours.
An analgesic such as codeine may be helpful initially and
heel elevation should be provided for several weeks.
What not to do:
Do not bother getting x rays of the area unless there is a
suspected associated bony injury. This is a soft tissue
injury that is not generally associated with fractures.
Discussion
The plantaris muscle is a pencil-sized structure tapering
down to a fine tendon which runs beneath the gastrocnemius
and soleus muscles to attach to the Achilles tendon or to
the medial side of the tubercle of the calcaneus. The
function of the muscle is of little importance and, with
rupture of either the muscle or the tendon, the transient
disability is due only to the pain of the torn fibers or
swelling from the hemorrhage. Clinical differentiation from
complete rupture of the Achilles tendon is sometimes
difficult to make. Most instances of "tennis leg" are now
felt to be due to partial tears of the medial belly of the
gastrocnemius muscle or to ruptures of blood vessels within
that muscle. The greater the initial pain and swelling, the
longer one can expect the disability to last.
