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The plantaris muscle is a small muscle with a short belly and a long, slender tendon that runs alongside the Achilles tendon. Its function is to work with the Achilles tendon to flex the ankle and knee joint. The plantaris muscle is prone to rupture, especially during lunging motions while running or jumping, and is a common injury among tennis players. This injury is often referred to as tennis leg. A rupture of the plantaris muscle can be differentiated from an Achilles tendon tear as the foot can still be pointed downward following the rupture. Treatment for a plantaris muscle rupture typically involves non-surgical methods, such as rest, ice, compression, and elevation, and symptoms usually resolve within a few weeks.
| Characteristics | Values |
|---|---|
| Common names | Plantaris muscle rupture, "tennis leg" |
| Affected body parts | Calf, ankle, knee |
| Symptoms | Pain, swelling, snapping sound, discomfort, tightness, inability to walk |
| Causes | Running, jumping, lunging, sudden muscular action |
| Diagnosis | Physical examination, ultrasound imaging, MRI, X-ray (if bone injury is suspected) |
| Treatment | Rest, ice, compression, elevation, soft tissue manipulation, massage, progressive strengthening exercises, PRICE/POLICE protocols |
| Recovery time | Several weeks to eight weeks |
| Prevalence | Common in tennis players |
| Related conditions | Achilles tendon tear, deep vein thrombosis (DVT), rupture of Baker's cyst, calf neoplasms |
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What You'll Learn
Plantaris muscle rupture symptoms
The plantaris muscle is a fine, rope-like tendon that runs alongside the larger Achilles tendon. It helps the Achilles tendon to flex the ankle and knee joints. The most common mechanism of rupture is the dorsiflexion of the ankle with the knee in full extension, which results in the simultaneous active contraction and passive stretching of the muscle. Plantaris ruptures occur most frequently during a lunging motion while running or jumping.
The rupture of the plantaris muscle can be differentiated from an Achilles tendon tear by the ability to point the foot downward following the rupture. With an Achilles tendon tear, this is not possible. Plantaris ruptures can also be mistaken for deep vein thrombosis (DVT), a blood clot in the large veins of the calf, which can be dangerous.
If the diagnosis is unclear, ultrasound imaging and MRI scans can be performed to confirm or exclude the diagnosis of a plantaris rupture.
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Plantaris muscle rupture diagnosis
Plantaris muscle rupture, commonly known as "tennis leg", involves a tear or rupture of the plantaris muscle and possibly the medial head or inside of the gastrocnemius muscle, which is the larger of the two calf muscles. The plantaris muscle is a fine, rope-like tendon that runs alongside the larger Achilles tendon. It helps with ankle and knee flexion by extending from the outside (lateral) back of the femur.
Plantaris muscle ruptures usually occur during a lunging motion while running or jumping. The injury is common in tennis players, hence the term "tennis leg". Patients often report hearing a pop in the back of their calf.
Diagnosis
The diagnosis of a plantaris muscle rupture can be made through a physical examination and by taking a patient history. Ultrasound imaging and MRI scans can also be used to confirm the injury. MRI scans are particularly useful in differentiating and characterising plantaris muscle injuries. Unless there is a bony injury, x-rays of the area will not be useful.
It is important to distinguish plantaris muscle ruptures from Achilles tendon tears, as the former allows the foot to be pointed downward, whereas the latter does not. Plantaris ruptures can also be mistaken for deep vein thrombosis (DVT), a blood clot in the large veins of the calf, which can be dangerous.
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Plantaris muscle rupture treatment
Plantaris muscle rupture, commonly known as "tennis leg", involves the plantaris muscle and possibly the medial head or inside of the gastrocnemius muscle, which is the larger of the two calf muscles. The plantaris muscle is a fine, rope-like tendon that runs alongside the larger Achilles tendon. It works with the Achilles tendon to flex the ankle and knee joints.
The rupture usually occurs during a lunging motion while running or jumping, and patients often report hearing a pop in the back of their calf. Plantaris muscle ruptures can be differentiated from an Achilles tendon tear as the foot can still be pointed downward following the rupture. However, ruptures can be confused with a blood clot in the large veins of the calf, known as deep vein thrombosis (DVT), which can be dangerous.
Treatment
Treatment of a plantaris muscle rupture is almost always non-surgical. The symptoms can be treated with simple steps, and they almost always resolve with conservative treatment. The R.I.C.E. method (rest, ice, compression, elevation) is typically used first and may be all that is needed. Short-term use of non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce pain and inflammation, but long-term use is not advised due to potential side effects. If the pain is significant, immobilization or crutch use may be required to allow the pain to subside.
Soft tissue manipulation and massage can be used to directly stimulate repair. Elastic support from foot to knee may be beneficial, and physical therapy with range-of-motion exercises and a gradual strengthening program is an important aspect of management. With conservative treatment, symptoms will gradually resolve over several weeks, and full recovery may take up to eight weeks depending on the severity of the injury.
Ultrasound imaging and MRI scans can be used to confirm the injury and rule out other conditions.
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Plantaris muscle anatomy
The plantaris muscle is a small, long, and slender muscle with a short belly and a long, thin tendon. It is located in the posterior compartment of the leg, extending behind the knee and into the sural region (calf) of the posterior leg. The muscle is one of the most superficial muscles within the posterior compartment of the leg, with only the gastrocnemius muscle overlying it.
The plantaris muscle arises from the inferior end of the lateral supracondylar line of the femur, just above the lateral head of the gastrocnemius muscle. Its tendon then travels inferomedially along the medial border of the gastrocnemius, beneath the gastrocnemius and soleus muscles, and attaches to the medial side of the calcaneus (heel bone). The plantaris tendon is the longest tendon in the human body, typically measuring between 30-45 centimetres in length.
The plantaris muscle is innervated by the tibial nerve, a branch of the sciatic nerve in the sacral plexus. It receives blood from the popliteal artery. The muscle acts to weakly flex the ankle and knee joints, working in conjunction with the Achilles tendon. It also provides proprioceptive feedback to the central nervous system regarding the position of the foot.
The plantaris muscle is absent in around 7-20% of the population, with some individuals having variations such as a double- or triple-headed plantaris muscle. Its function is considered relatively insignificant, and its removal does not typically affect lower extremity function.
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Plantaris muscle rupture risk factors
The plantaris muscle is a small, cord-like structure located in the calf at the back of the lower leg. Rupture of this muscle is an uncommon injury, often associated with other more significant tendon or ligament tears. Due to its small size and limited function, a plantaris muscle rupture may go unnoticed, as it often does not cause any noticeable symptoms. However, certain factors can increase the risk of sustaining this type of injury.
One key risk factor is participation in certain sports, especially those involving sudden changes in direction or explosive acceleration. Sports such as soccer, basketball, and tennis, which require quick starts, stops, and direction changes, can place extra stress on the plantaris muscle. Additionally, activities with a high impact or those that involve repetitive loading of the calf muscles, such as running (particularly uphill or sprinting), jumping, or dancing, can also increase the risk of a plantaris muscle rupture.
Age is another factor, with individuals over the age of 40 being more susceptible to plantaris muscle ruptures. This may be due to the natural process of aging, which can lead to a gradual loss of muscle mass and flexibility, making the muscle more vulnerable to injury. Additionally, pre-existing conditions or previous injuries can play a role. Individuals with tight calf muscles or a previous history of calf muscle strain are at higher risk. The plantaris muscle is closely associated with the Achilles tendon and the gastrocnemius and soleus muscles, which work together as a group. A previous injury or inflammation in this area can increase the likelihood of a plantaris muscle rupture.
Finally, traumatic incidents, such as a fall or a direct blow to the calf muscle, can also lead to a plantaris muscle rupture. This type of rupture is often associated with more severe trauma and may be accompanied by other injuries. It is important to note that while these are risk factors, many people who experience a plantaris muscle rupture may not have any obvious reason or fall into any specific risk category. Early diagnosis and appropriate management are essential to ensure optimal recovery and to rule out any associated injuries.
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Frequently asked questions
The plantaris muscle is a small muscle with a short belly and a long, slender tendon. It is located at the back of the leg, running alongside the Achilles tendon. A plantaris muscle rupture involves a tear in the plantaris muscle and possibly the medial head or inside of the gastrocnemius muscle.
Patients often report hearing a popping sound in the back of their calf, along with severe pain. Other symptoms include pain and/or tightness during and after physical activity.
Treatment of a plantaris muscle rupture is typically non-surgical. The RICE (Rest, Ice, Compression, Elevation) method is often used first and may be all that is needed. Soft tissue manipulation and massage can also help stimulate repair.
With conservative treatment, symptoms will gradually resolve over several weeks. Full recovery may take up to eight weeks, depending on the severity of the injury.
