Musculo-skeletal   [back to the Category]

Disinsertion of the medial gastrocnemius or tennis leg   [read the french version]

Author :   Docteur Anne Thiescé

This accident usually occurs in dancers over the age of 40, teachers or choreographers, during an impulsion or jump landing. It consists of an intense, sudden pain, like a lash stroke, half-way down the calf. The immediate disability can be complete or allow walking on demi-pointe.

Clinical examination reveals a swollen calf and bruising that is often widespread going progressively down to the ankle. Palpation is very painful and calf ballottement reduced. Dorsiflexion of the foot is painful when the knee is extended.

The diagnosis is confirmed by echographia on the third or fourth day. Evolution can, hence, be monitored and, in the case of a large haematic accumulation, a controlled puncture can be performed.

Given such a pathology, the following disorders can be eliminated: a rupture of the Achilles' tendon, phlebitis, a rupture of popliteal cyst: cyst situated in the posterior section of the knee, connected to the articulation.


Treatment is two-stage:

- Immediate stage: ice application, elevation and compression of the lower limb. A medical treatment of analgesics and muscle relaxants might be required. Anti-inflammatories taken internally must not be used until the second or third day because of their blood platelet anti-sludge properties which encourage bleeding.

- Delayed stage: resume walking using heel pads, physiotherapy and progressive stretching. An echographia controlled puncture is sometimes necessary and is performed on the tenth day. Re-education allows sporting activities to be resumed after six to eight weeks.

- Occasionally, evolution is not good. Echographia and M.R.I. show a cicatricial cyst. Treatment is then surgical. Walking and re-education can then be resumed immediately.

Bibliographie :

Rodineau J.: Les lésions musculaires. Ed. Laboratoires Besins Iscovesco.