Plantaris tendon tear
Acute onset calf pain whilst playing tennis - "like being hit from behind"
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Focal, fusiform swelling and reduced echogenicity in the plantaris tendon medially corresponding to the site of the patient's pain. Tendon above and below is normal on transverse scanning. Note increased surrounding blood flow.
This is the less common cause of acute onset severe calf pain in older persons performing sports (weekend warriors). More commonly the musculo-tendinous junction of the medial gastrocnemius is responsible. Treatment is the same i.e. expectant.