The calf muscles and Achilles tendon form our ‘propulsion system’ when walking and running and due to their design and their attachment to the heel are incredibly efficient in this action.

Injury to the calf muscles generally comes in the form of a tear or strain, often due to a sudden burst of acceleration, or a contusion resulting from direct trauma. Injury can also result from repetitive microtrauma to the muscles over longer periods of time, often as a result of various biomechanical issues.

Cramps are common in the calf region and can occur at rest or after exercise. They tend to occur in the more conditioned athletes and experience suggests that subtle nerve irritation in the region may be a factor in some cases.

The Achilles tendon is the thickest and strongest tendon in the body. Overuse injuries (tendinitis, tendinosis) are especially common in runner’s who are 30 times more likely to develop these problems than sedentary individuals. Traditionally tendon problems have been thought to be due to inflammation, but it is now well established that the pathology degenerative change within the tendon. Strengthening exercises to progressively load the tendon in a controlled way are effective in reversing this pathology.

Complete rupture of the Achilles tendon occurs predominantly in the 30-40 age group, patients often describe the feeling ‘as if being kicked in the back of the leg’. Surgical repair of the tendon is generally indicated for most people followed by a period of intensive physiotherapy to restore ankle range of movement and strength of the calf musculature.

Since most injuries to the calf / Achilles tendon region are gradual in onset treatment focuses on identifying and managing the underlying causes of the injury which are often biomechanical in nature.

Subtle changes to foot shape and structure (‘skeletal drivers’) such as external tibial torsion, forefoot supinatus / rearfoot varus, and Hallux limitus drive over-pronation of the foot placing increased load on the inner half of the calf musculature and Achilles tendon. The presence of a forefoot equinus increases loading of the calf musculature as the foot’s point of contact with the ground when running is closer to the forefoot – in fact many of these people with this skeletal driver do not heel strike at all when running. Gait analysis performed by an experienced Podiatrist is required to identify these issues and to determine whether a combination of orthotic devices or running shoe advice is needed.

Physiotherapy has a major role in treating injuries in this region. Calf strength and flexibility must be optimised with specific exercises. Manual therapy and soft tissue therapy techniques are used to normalise tissue compliance, while correct dynamic alignment of the entire lower limb is optimised with relevant muscle conditioning exercises.