Chapter 28

Tibia and fibula are connected by proximal and distal tibiofibular articulations and by an interosseous membrane between the bones through the entire length. The relevant anatomy of the leg is depicted in Figures 28-1, 28-2, 28-3, and 28-4. One head of gastrocnemius muscle arises from the medial and the other from the lateral condyle of the femur. Distally gastrocnemius inserts into the tendon of the Achilles. Achilles tendon is a common tendon formed by the gastrocnemius and soleus muscles which inserts into the posterior calcaneus. Peroneus longus arises from the lateral surface of the fibula and is inserted into the base of the first metatarsal and medial cuneiform. The peroneus brevis originates from the lower two-thirds of the lateral surface of the fibula and is inserted into the base of the fifth metatarsal.

###### Figure 28-1

Anatomy of the leg. (Used with permission from Van De Graaff KM. Human Anatomy, 6th ed. New York: McGraw Hill; 2002.)

###### Figure 28-2

Anatomy of the leg. (Used with permission from Van De Graaff KM. Human Anatomy, 6th ed. New York: McGraw Hill; 2002.)

###### Figure 28-3

Anatomy of the leg. (Used with permission from Van De Graaff KM. Human Anatomy, 6th ed. New York: McGraw Hill, 2002.)

###### Figure 28-4

Anatomy of the leg. (Used with permission from Van De Graaff KM. Human Anatomy, 6th ed. New York: McGraw Hill; 2002.)

### Definitions and Epidemiology

Acute strains are defined as stretching, partial thickness tears, or full thickness tears of the gastrocnemius muscle, usually of the musculotendinous portion, seen most commonly in adult (older adults) tennis players. It is less common in young athletes but can occur in highly competitive adolescent tennis players.1–3

### Mechanism

Strains occur after prolonged play, in fatigued muscle, with forceful and sudden eccentric contraction as in a tennis player running toward the net and then forcefully decelerating to a stop to hit a tough shot. It occurs more commonly in poorly conditioned athletes, and those who play an excessive number of sets.

### Clinical Presentation

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