Disclosures: David Nieves, MD: No financial relationships or conflicts of interest

Case Diagnosis: Patient with left leg pain, found to have a plantaris rupture.

Case Description: Patient presented with 5 days of left leg pain, described as “calf tearing.” Pain worsened while standing and walking, improved with rest, and did not radiate to her knee or foot. She denied any numbness or tingling.

Setting: Musculoskeletal ClinicAssessment/

Results: On physical exam, left calf bruising was seen, and there was tenderness to palpation along the medial gastrocnemius. Plantar and dorsiflexion were limited by pain. Thompson’s test was negative. Initial diagnosis was a medial gastrocnemius strain, but due to the tenderness, an MRI was ordered. MRI identified a plantaris tendon rupture with mild fluid tracking along the myofascial planes without hematoma. Patient was referred to physical therapy and recommended to use an off-loading boot while walking.

Discussion: The plantaris is a small muscle in the posterior compartment, originating at the lateral supracondylar line of the femur and the oblique popliteal ligament of the knee and inserting onto the calcaneus. It is an insignificant flexor, believed to be a vestigial muscle. Clinically, it is used as a tendon graft, due to its anatomy. Tears occur most frequently during running or jumping due to an eccentric load across the ankle with knee extension. Patients feel calf trauma, and pain with dorsiflexion or resisted plantarflexion. MRI and Ultrasound are the primary imaging modalities for diagnosis. Treatment consists of conservative management with RICE; permanent disability rarely occurs. Surgical management is indicated when a posterior compartment syndrome occurs, secondary to swelling and hematoma formation.

Conclusion: When evaluating lower extremity muscular injuries, it is important to order appropriate imaging for full evaluation. Our patient had progressive pain, and while initial management of a gastrocnemius strain and a plantaris tendon rupture is similar, it is important to evaluate for posterior compartment syndrome, which can lead to compromise of neurovasculature.

Level of Evidence: Level V

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