One of the possible causes of calf pain is a plantaris tendon tear. Plantaris is a small muscle that is thought to be vestigial. It has a long tendon that spans over two joints, making it susceptible to tears.
The plantaris muscle runs in the posterior compartment of the leg, as part of the triceps surae muscle group, while its tendon attaches to the calcaneus bone of the foot either independently or after converging with the Achilles tendon. The plantaris tendon stretches over both the knee and ankle joints, which makes it particularly susceptible to rupture, commonly occurring when the knee is extended while the ankle joint is dorsiflexed . It is a frequent injury in tennis players and has sometimes been referred to as tennis leg, although it is generally agreed that this term, more often than not, describes injury of the gastrocnemius muscle, with or without concurrent soleus muscle injury. Loss of limb function is not a typical finding in a plantaris tendon tear (PTT), furthermore, the muscle is capable of repairing itself without the aid of surgery . PTT has features similar to other more serious conditions such as deep vein thrombosis (DVT), Achilles tendon rupture and malignancy, which may need further, sometimes invasive intervention .
Although extremely rare, PTT may occur in isolation, or more frequently in combination with other muscle injuries such as trauma to the Achilles tendon  . It is mostly reported in young active individuals and older patients with a sedentary lifestyle.
Symptoms of PTT are calf pain and tenderness that gradually increase after physical activity is stopped, swelling, and a popping or tearing sound. These are acute in onset. Cases in the past have been diagnosed surgically.
Health Center, ASPIRE Doha Qatar 3. Struttura complessa di Radiodiagnostica Ospedale Galliera Genova Italy [link.springer.com]
[…] ligamentous damage (chronic and acute) Bursitis Joint effusion Vascular pathology Haematomas Soft tissue masses such as ganglia, lipomas Classification of a mass eg solid, cystic, mixed Post surgical complications eg abscess, oedema Guidance of injection, aspiration [ultrasoundpaedia.com]
- Calf Pain
Conclusion The causes of calf pain are multiple, and often difficult to diagnose clinically. [radsource.us]
One of the possible causes of calf pain is a plantaris tendon tear. Plantaris is a small muscle that is thought to be vestigial. It has a long tendon that spans over two joints, making it susceptible to tears. [symptoma.com]
The deep calf pain persists and may be accompanied by mild to moderate swelling and ecchymosis. Neurovascular function will be intact. [aneskey.com]
Symptoms Patients often report hearing a pop in the back of their calf. Pain and swelling most commonly at the junction of calf muscle and the Achilles tendon, the location of the rupture. [stoneclinic.com]
- Heel Pain
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Heel pain may arise from the fat pad itself. [pubs.rsna.org]
pain, need for revisional surgery, and/or catastrophic loss. [bunionsurgeryny.com]
Heel pain. (It may be severe.) Not being able to go on tiptoe with the hurt leg. [northshore.org]
- Leg Cramp
On a cold morning a few weeks ago while rushing forward to get a drop shop something hit me like an immediate leg cramp and i made a soft fall on the ground. I even heard a sound that wasn't a pop, but more like a paper tearing. [tt.tennis-warehouse.com]
Typical symptoms of a plantaris muscle rupture include: Sudden pain in the back of the calf A swelling or bunching of the calf muscle Swelling and bruising in the back of the leg Cramping and spasm sensations of the calf muscle Diagnosis The most important [verywell.com]
- Tendon Disorder
Drug-induced tendon disorders. Adv Exp Med Biol 2016; 920 : 229–238. [ PubMed ] [ Google Scholar ] 3. Braun D, Petitpain N, Cosserat F, et al. Rupture of multiple tendons after levofloxacin therapy. [ncbi.nlm.nih.gov]
- Unable to Walk
The patient is unable to bear weight, unable to walk and is obviously in severe distress. The patient with the plantaris tear can often hobble, walk and mobilize, but is simply in moderate distress. [southplattesentinel.com]
You may be unable to walk without help from crutches, even then it will be difficult to weight bear and many people choose to hop instead! Management of these injuries varies considerably and will be guided by your consultant or physiotherapist. [running-physio.com]
Where injuries are more severe, the exact mechanism of injury is easier to recall and/or the individual may be unable to walk due to severe pain. A calf muscle tear is graded from I to III, with grade III being the most severe. [physio-pedia.com]
To distinguish a plantaris tendon tear from other disorders, a number of imaging studies are employed . They include the following:
- Ultrasound: This is a useful tool in visualizing the vasculature and musculature of the leg while ruling out differentials  . Hematomas and fluid collection can easily be seen. Longitudinal scanning of the calf reveals PTT, which may appear as a fluid compartment between the soleus and gastrocnemius muscles . The latter may be the only sign of pathology and indicates plantaris tendon strain  .
- Magnetic resonance imaging (MRI): This is one of the main imaging tools that are employed. In addition to confirming the diagnosis, it may also be utilized to assess the severity of the injury, including involvement of other muscles . A normal MRI warrants further investigation, as the likelihood of a deep vein thrombosis, is increased.
- Diagnosis through surgical means has been used in the past.
- Color Doppler: This technique is efficacious in revealing findings of DVT.
- MR venography.
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