Pain in Back of Calf Down to Ankle
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Is your calf pain due to a pulled calf muscle or something else?
Sudden calf pain during sport is often due to a calf tear or pulled calf muscle. A calf tear is also known as a calf strain or tennis leg as it is common in active people especially athletes.
However, the cause of calf pain could be due to something else including Achilles tendon tear, blood clot, blood vessel swelling (also called an aneurysm), or Baker's cyst. In general, it is important to see your doctor to confirm the diagnosis of a pulled calf muscle or tennis leg.
What is a pulled calf muscle?
A pulled calf muscle, also known as a calf strain, is an injury to the muscle rather than ligaments as occurs in a sprain. In a calf strain, the muscles are overloaded and overstretched causing tearing and swelling. Overload occurs due to too much force on the muscle during acceleration or sudden change in direction.
Calf tears can occur in one of two muscles in the calf: the superficial gastrocnemius muscle or the deeper soleus muscle.
Tennis leg
Tennis leg is the name given to tears of the gastrocnemius muscle. This injury presents as sudden calf pain while playing sports including tennis. Often, you experience sudden calf pain and a snapping or popping sensation. Usually, you can't continue with your exercise due to pain. Later, you develop significant swelling and bruising into the calf and find it difficult to put all your weight on the leg.
Tennis leg is associated with a rupture of the medial gastrocnemius muscle with swelling collecting between the muscles in the calf.
Recently, Dr Masci co-authored a paper on using ultrasound to diagnose a gastrocnemius muscle tear. Importantly, the exact location of the tear determines how long it takes to heal and return to sport. Bottom line is that you need an ultrasound if you tear your gastrocnemius muscle to know how to treat it properly. For example, if you develop bleeding in the muscle, we suggest draining the bleeding to speed up healing and avoid too much scar tissue. Moreover, a large tear will mean you need a boot for a few weeks.
Can I swim with a pulled calf muscle?
Generally, the answer is yes. Swimming works other muscles apart from the calf muscle and is a good option to maintain fitness while you recover.
How to treat a pulled calf muscle
We suggest rest from sport, compression, ice packs for 10 minutes every 2-4 hours, heel lifts, and crutches if you are limping. This acute treatment should continue for 48-72 hours. Once you can walk without pain, we suggest you start a calf strengthening program supervised by a therapist. Then, once you've regained strength, you can progress into skipping, jumping and finally running.
It is important you see an experienced sports doctor to get a proper diagnosis and discuss timeframes regarding return to sport.
Soleus tear
A tear of the deeper soleus muscle is also a cause of calf pain. However, symptoms are often different from a gastrocnemius tear. Firstly, pain is often gradual onset rather than sudden. Secondly, you often find that you can continue playing sport even after developing a soleus tear. But as you continue, you find that the pain becomes unbearable and you have to stop.
Unlike gastrocnemius tears, soleus tears can be misdiagnosed as tight muscles or muscle cramping, especially during the early stages. In addition, unlike gastrocnemius tears, soleus tears are hard to find on ultrasound. We suggest an MRI scan to diagnose a tear. Also, the site of the tear determines how much time you need off sport with central tendons tears taking the most time.
Other causes of calf pain
While most link sudden calf pain to a muscle injury, there are other causes, and some are quite serious such as a blood clot. It is important you see your doctor to get a better idea about a diagnosis. Potential causes include:
Calf muscle cramping
A far less severe cause of calf pain is a simple cramp. Sometimes, cramping can be difficult to distinguish from a soleus muscle tear. Often symptoms are milder and short-lived.
Blood clot
A clot in the veins can produce swelling, pain, and redness of the calf. Importantly, the clot can dislodge and move to the lungs causing a life-threatening complication. If we suspect a blood clot, then a special ultrasound or blood test is needed. Sometimes, it can be difficult to pick a clot from a muscle tear.
Blood Vessel Aneurysm
The swelling of a blood vessel at the back of the knee is also called an aneurysm. Why some people develop swelling is unknown. The danger of aneurysms is the increased risk of rupture that could lead to loss of limb. Aneurysms need immediate surgery if large or are causing symptoms such as pain at the back of the knee or calf.
Baker's cyst
A Baker's cyst is a pocket of fluid at the back of the knee coming from the knee joint. The cyst can increase and decrease in size depending on swelling in the knee joint. Sometimes, the cyst can burst causing pain and swelling in the calf similar to a calf tear or a blood clot. Dr Masci has written about Baker's cyst in a previous blog.
Achilles tendon rupture
Most people don't realise that the Achilles tendon starts from the heal and extends to the mid-calf. So, sudden pain in the mid-calf could be due to a tear of the Achilles tendon rather than a calf muscle. Tears of the Achilles tendon can be similar to a tennis leg or gastrocnemius tear – sudden mid-calf pain with a popping sensation. A full tear of the Achilles tendon will need immobilisation in a walking boot followed by a slow recovery. In some cases, surgery is needed.
Final word from Sportdoctorlondon about a pulled calf muscle
If you experience sudden severe pain in your calf, you need an expert to work out the cause. Often, imaging such as an ultrasound or MRI is required. Finally, you need proper treatment to get you back to sport or prevent complications, some of which could be life-threatening.
Other related calf conditions:
- Baker's cyst
- Use of ultrasound in diagnosing tennis leg
- Calf tear webinar
Dr. Masci is a specialist sport doctor in London.
He specialises in muscle, tendon and joint injuries.
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Pain in Back of Calf Down to Ankle
Source: https://sportdoctorlondon.com/pulled-calf-muscle/
5 Comments
Lower calf muscle tightness (right leg only) after about 1/2 klm walking,stretching before walk and then when tightened, gives some relief,has been problem for about 6 months,before that daily walks 4
-6 klm no problem age 77 any suggestions ?. Weights 75kiloCheers
Hi Bob – my thoughts – it could be referred from your lumbar spine – we call this neurogenic claudication – or perhaps due o problems in the calf muscle itself. I'd suggest seeing a PM and R doctor or sports doctor to clarify the diagnosis.
Lorenzo
Dr. Masci, Thank you so much for the clear descriptions of calf injuries. I am now better informed and 90% sure that I have a small tear in my inner Soleus on my left leg. Next step is to get better and figure out how to not do that again.
Hi, I got a sudden pain just below the back of my knee whilst doing a keep fit class. Unable to continue and now unable to put weight on it to walk. I'm an active 68 year old female. I play badminton and walk around 11km regularly. Any suggestions as to what happened?
Hi Carol,
Pain just below the back of the knee can be due to a number of causes.
https://sportdoctorlondon.com/pain-behind-knee/
I suspect you have pulled a calf muscle – if it's near the knee, then you've probably pulled the deeper soleus muscle. However, you should see a specialist sports doctor if the pain does not settle.