Injury to the gastrocnemius muscle is among the more common injuries to occur in the lower leg. Like the hamstring and quadriceps muscles the gastroc-nemius is prone to injury as it spans two joints and has a high proportion of fast-twitch type 2 fibers [102]. The medial and lateral heads of gastrocnemius arise from separate proximal attachment sites on the posterior aspect of the femoral condyles [26]. Distally the heads form a flat aponeurosis at the distal myotendinous junction before coalescing with the soleus aponeurosis to form the Achilles tendon.

The medial head is injured more commonly than the lateral head as it has been shown to be more active [103]. In a series of 20 MRIs of the distal myo-tendinous junction, the medial head was more commonly involved 19/22 versus lateral 3/22 [104] (Fig. 23). It is important to have high clinical suspicion for deep venous thrombosis (DVT) in patients with calf pain as patients may have DVT mimicking muscle strain or a DVT may be associated with the muscle strain injury. Thrombophlebitis is also within the differential for calf pain [105] (Fig. 24).

Because of the superficial nature of injury, ultrasound evaluation is reliable and offers concomitant ability to easily exclude the presence of deep venous thrombosis or provide image guidance for needle aspiration of fluid collections [106,107].

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