The calf is the part of the foot located between the knees and the foot. The skeleton of the calf consists of two bones: the tibia and the peroneum (the peroneum is also called the fibula). The calf muscles, by their action, play an important role in walking and running. They are divided into 3 large groups: the anterior, lateral and posterior muscles of the calf. Calf pain usually involves the posterior muscles.

The muscles of the posterior region are placed in two planes, deep and superficial. The muscles of the deep plane are: ➢ the long flexor muscle of the toes ➢ the posterior tibial ➢ the long flexor muscle of the hallux (big toe) ➢ the popliteal muscle The muscles of the superficial plane are: ➢ The gastrocnemius or twin muscles, which have 2 heads, medially and laterally (hence the name of twins) ➢ The soleus muscle These muscles are inserted through a common tendon, called the Achilles tendon, on the calcaneal tuberosity. The muscles of the superficial plane are those that can suffer injuries, caused by various factors, from a minor sprain to more serious conditions, such as a deep vein thrombosis.

Muscle sprawling or muscle contracture (cramp) are indirect injuries occurring because of fatigue or overstraining of the muscle. They can occur during any type of physical activity: running, lifting weights, climbing, swimming, but also without physical effort, these being called "occupational". For example, maintaining abnormal postures for long periods of time or poor body posture can cause chronic muscle sprawling or contractions of the neck, shoulders and back. Dehydration can also lead to the occurrence of muscle cramps. Most cramps are harmless and are relieved by gentle massage, by a slight stretching of the muscle or by applying a warm towel. Rarely, muscle cramps can be caused by other conditions such as certain compressed nerves, a situation in which you have to go to the specialist. Rest, ice or heat applied locally, as well as elevation (raising the calf higher than the height of the hip) have beneficial effects in treating muscle injuries. But patience is essential; an injured muscle can take up to 6 weeks to heal completely.

The Achilles tendon connects the calf muscles to the calcaneus (heel bone). An inflammation or injury of the Achilles tendon causes pain, more pronounced after physical effort. The calf muscles may also feel stiff and inflamed, especially in the morning. Achilles tendonitis often improves with treatment that involves: rest, locally applied ice for 10-15 minutes 3-5 times/day, compressive bandage and elevation. Also, nonsteroidal anti-inflammatories, administered for several days and physical therapy are indicated in the treatment of Achilles tendonitis

THE BAKER CYST

A Baker's cyst is a small swelling caused by fluid coming from the knee joint, a swelling located behind the knee, in the popliteal area. When a large amount of fluid in the knee joint is compressed, through the weight of the body, between the bones of the knee joint, the fluid ends up separating from the joint forming a bag. Any knee injury causes an increase in the amount of synovial fluid in the joint. Normally, synovial fluid allows the joint to slide properly and also provides it with the necessary nutritional intake. In the Baker cyst condition, the knee joint trying to better lubricate the knee when it suffers from an injury, produces excess inflammation fluid. Thus redness and pain appears behind the knee, which can also irradiate in the calf. Sometimes, the Baker cyst disappears on its own. In most situations, however, it is necessary to visit a doctor or a physical therapist.

Prolonged standing or walking over very long distances leads to increased pressure on the legs, which can cause varicose veins at the level of the calf. These thick, swelled veins can cause pain, burning sensation, swelling and itching. Compression stockings can help. As well as movement and exercise, they help pump blood to the calf. Surgery is also useful to close or shrink the veins.

The sciatic nerve is the longest and thickest nerve in the body, at the point where it is the thickest having the size of the width of the thumb. It begins at the level of the lumbar spine, the nerve roots leaving the spinal marrow at the level of the L4 vertebra and descending on the posterior part of the lower limb. If the sciatic nerve is brushed or inflamed, you may feel a pain or burning sensation that goes down to the calves. Sciatica (inflammation of the sciatic nerve) can also worsen after a longer period of sitting down. Locally applied ice, 10-20 minutes, 1-3 times a day, significantly helps reduce inflammation, as well as drug treatment with nonsteroidal anti-inflammatory drugs, administered for periods of time not exceeding 7-14 days. Gentle massage and specific exercises help to decompress the nerve and relieve pain.

This condition involves the formation of a blood clot in a vein, usually in the thigh or lower leg, a situation in which the calf can hurt and feel warm. Obesity can predispose to deep vein thrombosis, as can pregnancy, smoking and sitting for long periods of time. As symptoms, pain and swelling of the foot appear, as well as reddening and more intense heating of the foot, compared to the unaffected leg. It is necessary to urgently go to the doctor because the blood clot can migrate into the lungs causing pulmonary embolism. With proper treatment, deep vein thrombosis can be prevented and/or treated.

Calf pain can be a sign that the leg muscles are not getting enough blood. The discomfort or muscle pain occurring when walking is called intermittent claudication and is due to the blockage of the arteries in the lower limbs, most commonly by the accumulation of cholesterol in the vascular wall, which causes insufficient blood supply to the muscles. For evaluation, tests can be performed to see how well the blood flows to the lower limbs. Certain medications and regular exercise help relieve symptoms and prevent other problems.

It occurs when there are problems in the peripheral nerve which can be injured somewhere on their trajectory. Peripheral nerves are the connection between the central nervous system (brain and spinal marrow) and the effector structures (muscles, glands). The most common cause is diabetes, but there are other conditions, medications, injuries or infections that can cause peripheral neuropathy. If the nerves in the legs are affected, manifestations such as: stinging, tingling or a feeling of weakness and/or pain in them occur. Because it is possible to make balance and gait to be difficult, physical therapy, through specific exercise programs, helps increase muscle strength and improve balance. Also, certain medications, recommended by a doctor help relieve pain.

Stress fractures are small cracks in the bones, including in the calf bones, which occur as a result of excessive physical effort. These are common in the case of performance athletes who are subjected to high intensity training, a situation in which the muscles around the bones are overworked and do not cushion the impact of the movement as they should. Rest along with physiotherapy and physical therapy is the best treatment for a stress fracture, but it can take up to 6 weeks for a complete recovery. Make sure that the fracture is completely healed before resuming physical activity in order to avoid relapses and/or other injuries.

Although it does not happen often, certain bacteria can sometimes enter the bones causing an infection and bone destruction, a condition known as osteomyelitis. Symptoms consist of localized bone pain and sensitivity to palpation. The infection localized in a leg bone, tibia or fibula, is associated with swelling of the calf and a feeling of local heat, fever and fatigue. If laboratory and imaging tests confirm a bone infection, the treatment consists of antibiotics and sometimes surgery.