History
An audible pop when the injury to the medial calf occurred is usually reported, and the patient complains of feeling like a stick struck his/her calf.
The patient complains of pain in the area of the calf, which also radiates to the knee or the ankle. In addition, the patient complains of pain with range of motion (ROM) of the ankle.
The patient complains of a swollen leg that extends down to the foot or ankle, as well as the associated color changes of bruising. (See also the Medscape Reference article Contusions.)
Physical Examination
Inspection
Asymmetric calf swelling and discoloration, potentially spreading to the ankle and foot, is noted on physical examination.
If the stage of swelling has resolved, a visible defect in the medial gastrocnemius muscle may be evident.
Palpation
Tenderness is noted upon palpation in the entire medial gastrocnemius muscle, but this tenderness is observed to be exquisitely more painful at the medial musculotendinous junction.
Depending on the degree of swelling, a palpable defect may be evident at the medial musculotendinous junction; however, with extreme swelling, this finding may not be appreciable.
Palpation of the Achilles tendon should demonstrate an intact tendon.
The peripheral pulses should be present and symmetric.
Provocative maneuvers
Moderate to severe pain is demonstrated with passive ankle dorsiflexion (due to stretching of the torn muscle fibers), as well as with active resistance to ankle plantar flexion (due to the firing of the torn muscle fibers).
