Chronic Calf Muscle Scarring

Summary

Chronic calf muscle scarring can occur following an injury to the calf muscle (gastrocnemius). Muscle injuries heals with scar tissue which is stiffer and thicker that the muscle. Chronic calf pain may result if the scar tissue is large, or in a sensitive area. Symptoms of chronic calf muscle scarring will often only be present during dynamic athletic activities such as running. Treatment with therapy to mobilize the scar tissue can be very helpful. Regular massage of the calf muscle or use of a foam roller may be necessary to help control the symptoms on an ongoing basis.

What is Calf Muscle Scarring?

Calf muscle injuries causes damage to the gastrocnemius muscle which can lead to localized muscle scarring with resulting chronic calf pain. Initially, a calf muscle injury has localized bleeding (bruising) around the injured muscle as part of the initial healing process. Over time, the injured muscle heals. However, the muscle heals with scar tissue rather than muscle. This scar tissue is thicker and stiffer than regular the calf muscle tissue. Often the calf muscle scarring that occurs following an injury is small and asymptomatic. However, depending on the size and location of the scar tissue chronic localized calf discomfort can occur. Larger calf muscle injuries will tend to heal with larger scars and have a greater likelihood of chronic calf symptoms. Additionally, scar tissue that adheres to the fascia that surrounds the calf muscle can also create discomfort. This is because when the calf muscle contracts the muscle tissue including the scar moves.  If the scar is attached to the fascia it may create local discomfort with each muscle contraction.

Clinical Examination in Patients with Calf Muscle Scarring

The area of calf muscle discomfort can be localized by palpation. In some patients the scar can be easily felt as a lump of harder tissue relative to the calf muscle. In some patients stretching the calf muscle will create symptoms. More commonly symptoms only develop with repetitive use of the calf muscle such as when running.

Imaging Findings in Calf Muscle Scarring

X-rays of the lower leg will usually be normal, unless there is calcification of the scar tissue within the calf muscle which is uncommon.

A high-resolution MRI performed on a patient with significant calf muscle scarring will often identify the scar tissue.

Treatment of Calf Muscle Scarring

Patients with mild irritation from localized calf muscle scarring may not require any specific treatment. However, if symptoms are persistent and are limiting activities, a 4-10-week course of physical therapy can be very beneficial. The therapist will focus on working to mobilize the scar tissue. Scar mobilization will be combined with gentle calf stretching. Activity modification to limit repetitive loading from running or walking may also be beneficial in the short term. Regular ongoing massage of the calf muscle may be necessary to keep calf muscle symptoms under control.

A very small percentage of patients may continue to have debilitating symptoms in spite of optimal physical therapy. In these patients surgery to free up the scar tissue may be an option. This type of surgery can work well in certain patients. However, there is a real risk of further scar tissue forming at the site of the surgery.

Edited to January 17, 2024