A 37-year-old female presented with a chief complaint of right posterior calf pain. She reported the onset of symptoms a few days earlier while feeding the cows. She experienced a sudden and sharp sensation at the back of her calf as she extended the leg backward while planting the heel on the ground to pivot with a bucket in her hand. She stated, “I thought a cow kicked the back of my leg…but when I turned around, there was no one there.” The pain was located along the medial aspect of the posterior calf and extended proximally toward the knee and distally toward the ankle. She described the pain as tight and throbbing. The pain was aggravated with general ankle movements.

Examination revealed an antalgic gait , favoring the right leg. She was unable to balance on the right leg unassisted. Inspection revealed moderate soft tissue swelling of the right calf with discoloration and bruising extending to the posterior aspect of the foot. Measurement of the calf was 41 cm on the right and 38.5 cm on the left, at 10 cm below the patella. A visible defect of the medial gastrocnemius muscle was evident and was palpable at this juncture. In addition, a mass was palpated at the posterior calf, likely the rupture of the gastrocnemius muscle. Palpation revealed tenderness along the entire medial gastrocnemius muscle, particularly at the musculotendinous junction.

The Thompson Squeeze Test was negative for an Achilles tendon rupture, as it was painful but produced plantar flexion. Active and passive ankle dorsiflexion produced moderate pain. Resisted plantar flexion of the ankle also reproduced the symptoms. There was mild pain with active knee flexion. There was difficulty performing a single-leg calf raise with the affected leg.

The patient was referred for a MRI and venous doppler of the right-lower leg. The patient has well-defined, localized pain that is aggravated with stretching. Patient was advised to limit activities. The use of a compression sleeve for the calf was recommended to decrease hemorrhaging. She was directed to apply ice to the area with 10 minutes on, 10 minutes off, and then repeat for symptomatic relief. Ms. Song was educated on the proper technique of elevating the limb slightly above the level of the heart to reduce the swelling. The patient was prescribed a walking boot to assist mobility and recommended to begin physical therapy.