Muscle soreness (post exercise)
Muscle injury esp. gastrocnemius tear
Claudication esp. vascular (intermittent)
Serious disorders not to be missed
Deep venous thrombosis
Peripheral vascular disease
Popliteal artery entrapment
Referred pain: knee, spine
Superficial posterior compartment syndrome
Nerve entrapment e.g. tibial, sural
Stress fracture of fibula
Motor neurone disease
Thyroid/other endocrine: hypocalcaemia
Spinal dysfunction: L5 referred
Is the patient trying to tell me something?
A history of the features of the pain-quality, onset (acute or slow), ‘tearing’ or ‘popping’ sound, relation to activity and associations esp. back or knee pain.
Document any preceding sporting activity, travel, immobilisation, varicose veins or claudication—neurogenic or vascular pattern.
Calf muscle examination incl. Achilles tendon, functional stress, swelling or bruising
Lumbosacral spine and knee of affected side
Veins and arteries of leg esp. peripheral pulses
Neurological—sensation, power, reflexes esp. ankle
Neurogenic claudication is muscular pain starting proximal and radiating distal on walking, and persists for a while after resting. Vascular claudication starts in the calf, radiates proximal and abates on rest.