Triceps surae muscle injuries-a clinical challenge more complex than you think

Calf muscle injuries are common in running and sprint-based sports, but remain too often grouped under a single label despite important differences between gastrocnemius, soleus and, less commonly, plantaris-related injuries. This review evaluates current evidence on anatomy, diagnosis, imaging, classification, prognosis, return to play, and recurrence.

A structured narrative review was undertaken using PubMed/MEDLINE and Scopus, with searches updated to 23 February 2026. After deduplication and screening, 82 articles were included, including eight seminal pre-window studies.

Calf injuries generate substantial time-loss and recurrence burden. Age and previous calf injury are the most consistent risk factors. The soleus has been underdiagnosed, while imaging is most useful when it clarifies anatomy and tissue involvement rather than replacing clinical judgement. Connective tissue disruption, particularly involving aponeurosis or intramuscular tendon, appears more prognostically relevant than oedema alone.

General muscle injury classifications improve terminology but incompletely capture the complexity of distal calf injuries. The precise prognostic value of MRI findings, isolated anatomical location and serial imaging remains uncertain, and return-to-play endpoints are inconsistently defined across studies.

The field is moving from oedema-based grading towards tissue-based, muscle-specific classification, especially for soleus and distal medial gastrocnemius injuries. Rehabilitation is increasingly understood as progressive re-exposure to running, elastic loading, and sport-specific demands rather than symptom resolution.

Priorities include harmonized definitions of recurrence and return to play, integrated prognostic models combining clinical, imaging and load data, and comparative trials of calf-specific rehabilitation.