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Posterior Lower Leg

Calf strains are a common injury. The “calf muscle” or triceps surae consists of three separate muscles (the gastrocnemius, soleus, and plantaris) attached to the heel via the Achilles tendon, the largest tendon in the body. They provide explosive power and propulsion. Differentiating strains in the gastrocnemius and soleus is particularly important for an accurate prognosis, appropriate treatment, and successful prevention of recurrent injury. Structured rehabilitation and careful treatment of scar tissue during the repair process are essential following injury. Your physiotherapist is an expert in designing and implementing a progressive programme of tissue management, strengthening, and balance retraining to get you back to full function and the activities you enjoy.

Treatment may include:

  • Gait re-education
  • Weaning from crutches
  • Weaning from boots or splints
  • Soft tissue massage
  • Scar tissue management
  • Stability exercises
  • Maintaining your current strength and  cardiovascular ability
  • Taping for proprioception and pain
  • Exercises to mobilise neural tissue
  • Assessment for biomechanical overload and the initial cause of the injury
  • Mobilising techniques to the bones in the foot and ankle
  • All types of post-operative rehabilitation
  • All types of comprehensive rehabilitation for fracture management in the lower leg, foot and ankle

Tears to the Calf Muscles
If a muscle is forcibly stretched or contracted beyond its limits the muscle tissue becomes torn. A tear in the calf is (classified depending on its severity) as a first, second or third degree strain:

A first degree strain is damage to a few muscle fibres, there may be a sensation of cramp or tightness and a slight feeling of pain when the muscles are stretched or contracted.

A second degree strain is damage to a more extensive number of muscle fibres and is classified as a moderate injury. Because there is a greater amount of tissue damage, a second degree strain will have significant impact on the functional ability of the leg. A patient may have swelling, localised bruising, muscle spasm, tenderness over the injury site, reduced or limited range of motion at the ankle, and weakness in the muscle.  It will hurt to walk. Over the next few days the bruising may track down the leg because of the effect of gravity.

A grade three strain is a complete rupture of the muscle either within the muscle belly or at the musculotendinous junction (where the muscle and the achilles tendon connect). There is an immediate burning or stabbing pain and the patient is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is. There is normally extensive bruising that appears shortly after injury and may be down the whole of the leg.

Achilles tendonopathy
Tiny tears in the tissue of the tendon occur with overuse. During the healing process, scar tissue is laid down by way of repair. This process can continue to the extent that a nodule forms within the tendon. The area may be noticeably thickened and tender to the touch. Pain is present with walking, especially when pushing off on the toes. This degenerative condition without inflammation is called tendonosis. The weakened, degenerative tendon can predispose to actual rupture of the Achilles tendon.

Achilles tendon rupture
An Achilles tendon rupture is usually an unmistakable event. Patients can report hearing a snap and will describe the feeling of being kicked in the calf. Following rupture the calf may swell, and the injured person usually can’t rise on to their toes. The tendon can also sustain partial rupture.

Tibialis Posterior
This muscle runs down the back of your shin bone on the side that is closest to the midline of your body. The tendon comes around the bony prominence on the inside of the ankle and has a number of insertions on the base of the foot. It is responsible for pointing your foot downwards and turning your foot in towards midline.

Biomechanically, as the foot flattens out with each step, tibialis posterior is lengthened causing it to repeatedly pull on its attachment at the tibia. In cases of overload, this can lead to pain and tenderness localised to the middle and distal third of the tibia on the inside of the shin. If you feel for the bony prominence on the inside of your ankle and run your thumb in a straight line up towards your knee you will be able to find your area of tenderness.

Tibialis posterior can also present with tendonitis which is discussed in the foot and ankle area of the body chart.

Sciatic Pain
If anything happens to impinge the sciatic nerve, it can become symptomatic. It is common to feel pain in the buttock, the back of the thigh, the outside of the lower leg and even the foot and ankle. There may be burning, toothache, numbness or pins and needles. There can be weakness in the muscle groups the sciatic nerve supplies and sensory perception can be reduced.