Posteromedial Calf Pain In A Tennis Player

A 44-year-old female presented with right calf pain while playing tennis 3.5 weeks ago. She was doing a cutting maneuver and felt acute, notable pain in the right medial calf with associated bruising and pain. She presented to her physical therapist and started doing physical therapy exercises over the past two weeks with near resolution of her symptoms, but when she returned to playing tennis, she reported recurrence of her symptoms. On presentation, she reported medial lower leg pain and bruising. On physical examination, she had no difficultly walking. She had no difficulty with toe walking or heel walking. There were no obvious step-off deformities appreciated along the Achilles tendon or the calf muscles. She had TTP over the medial gastrocnemius soleus interface. Thompson’s test was negative. DIFFERENTIAL DIAGNOSIS: 1. Muscle strain of the medial head of the gastrocnemius2. Achilles tendonitis3. Plantaris tear Imaging:Limited ultrasound of the right calf revealed a small fluid pocket appreciated in the medial gastrocnemius soleus interface fascial plane where the plantaris tendon runs. There was thickening and disruption of the fibrillar architecture of the plantaris tendon within this region concerning for a partial/near full thickness tear. There was tenderness with sonopalpation. There was mild hyperemia appreciated in the surrounding soft tissues. FINAL WORKING DIAGNOSIS: Plantaris tear TREATMENT AND OUTCOMES: 1. Continue physical therapy and home exercise program2. Avoid cutting and jumping activities including tennis for an additional 2 months3. Ice and head for additional analgesia4. If no improvement consider MRI for further evaluation5. Return to clinic in 2 months At 2-month follow-up, the patient reported improvement in symptoms, and she was ready to return to tennis. At this time, sonographic evaluation demonstrated scarring down of the plantaris tendon. We recommended that the patient slowly return to tennis with the guidance of her physical therapist to prevent reinjury with instructions to return as needed. At 3 months, patient returned to full competition with tennis.