From the Research
Treatment of a medial gastrocnemius tear typically involves nonoperative management, with surgery reserved for patients who require forceful plantar flexion for their desired activities or occupation, as stated in the most recent study 1. The initial management of a medial gastrocnemius tear involves a combination of rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours after injury.
- Patients should avoid activities that cause pain and may need crutches if walking is painful.
- Pain management can include over-the-counter medications like acetaminophen (500-1000mg every 6 hours) or NSAIDs such as ibuprofen (400-600mg three times daily with food) for 5-7 days, unless contraindicated. After the acute phase, gentle stretching and progressive strengthening exercises should begin, including calf raises, ankle pumps, and eventually heel drops.
- Physical therapy is often beneficial, focusing on eccentric strengthening exercises and proprioception training.
- A graduated return to activity should occur over 2-6 weeks, depending on tear severity. For severe tears, a walking boot or night splint may be prescribed for 1-2 weeks.
- Patients should understand that healing occurs in phases - inflammatory (0-7 days), proliferative (7-21 days), and remodeling (21+ days) - with complete recovery typically taking 3-8 weeks for mild to moderate tears. The use of platelet-rich plasma (PRP) injections has been shown to reduce the time to functional recovery in patients with gastrocnemius strains, as demonstrated in a retrospective observational study 2. However, the most recent and highest quality study 1 prioritizes nonoperative management, with surgery reserved for specific cases, making it the primary recommendation for treatment. It is essential to note that acute compartment syndrome is a rare but potential complication of medial gastrocnemius tear, and immediate fasciotomy is the treatment of choice in such cases 3. Ultrasound diagnosis can be useful in confirming the diagnosis and estimating the severity of the injury, as well as monitoring progress of healing 4.