9.28 Plantaris Tendon Rupture
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agk's Library of Common Simple Emergencies

Presentation
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The patient will come in limping, having 
suffered a whip-like sting in his calf while 
stepping off hard on his foot or charging the 
net during a game of tennis, or similar 
activity. He may have actually heard or felt a 
"snap" at the time of injury. The deep calf 
pain persists and may be accompanied by mild 
swelling and ecchymosis. Neurovascular function 
will be intact.

What to do:
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- Rule out an Achilles tendon rupture. Test for 
    strength in plantar flexion (can the 
    patient walk on his toes?). Squeeze the 
    Achilles tendon and palpate for a tender 
    deformity that repre sents a torn segment. 
    If pain does not allow active plantar 
    flexion, squeeze the gastrocnemius muscle 
    with the patient kneeling on a chair and 
    look for the normal plantar flexion of the 
    foot. This will be absent with a complete 
    Achilles tendon tear. With any Achilles 
    tendon tear, orthopedic consultation is 
    necessary.
- When an Achilles tendon rupture has been 
    ruled out, provide the patient with elastic 
    support (e.g., ACE, TEDs stocking, Tibi- 
    grip) from foot to tibial tuberosity.
- Provide the patient with crutches for several 
    days. Permit weight bearing only as comfort 
    allows.
- Have the patient keep the leg elevated and at 
    rest for the next 24-48 hours, initially 
    applying cold packs, and after 24 hour 
    alternately with heat every few hours.
- An analgesic such as codeine may be helpful 
    initially and heel elevation should be 
    provided for several weeks.

What not to do:
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- Do not bother getting x rays of the area 
    unless there is a suspected associated bony 
    injury. This is a soft tissue injury that 
    is not generally associated with fractures.

Discussion
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The plantaris muscle is a pencil-sized 
structure tapering down to a fine tendon which 
runs beneath the gastrocnemius and soleus 
muscles to attach to the Achilles tendon or to 
the medial side of the tubercle of the 
calcaneus. The function of the muscle is of 
little importance and, with rupture of either 
the muscle or the tendon, the transient 
disability is due only to the pain of the torn 
fibers or swelling from the hemorrhage. 
Clinical differentiation from complete rupture 
of the Achilles tendon is sometimes difficult 
to make. Most instances of "tennis leg" are now 
felt to be due to partial tears of the medial 
belly of the gastrocnemius muscle or to 
ruptures of blood vessels within that muscle. 
The greater the initial pain and swelling, the 
longer one can expect the disability to last.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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