Calf Injuries: An Anatomy-Based Approach to Diagnosis, Management and Return to Sport.

Abstract

Purpose of review: Calf muscle injuries are common in athletes but represent a heterogeneous group of lesions involving different muscles and myoconnective structures. This review provides a practical overview of gastrocnemius-soleus injuries, with particular emphasis on how anatomical characterization can contribute to diagnosis, management and return-to-sport decision-making. It also examines the limitations of current evidence and the extent to which increasingly detailed imaging findings translate into clinically meaningful information.

Recent findings: Advances in ultrasound and magnetic resonance imaging have improved the identification of specific injury patterns involving the gastrocnemius and soleus. Recent studies support moving beyond a muscle-based diagnosis towards more precise characterisation of the myoconnective structures involved. However, evidence linking individual anatomical patterns to prognosis and return-to-sport outcomes remains limited and largely observational. Current rehabilitation approaches favour progressive, criteria-based loading rather than fixed timelines, while return-to-sport decisions increasingly integrate clinical recovery, functional capacity, sport-specific demands and acceptable risk. No validated calf-specific rehabilitation or return-to-sport criteria are currently available. Anatomical characterization provides a useful framework for understanding the heterogeneity of calf muscle injuries but should inform rather than determine clinical management. Rehabilitation should remain function-led and progressively restore the mechanical capacities required for sport, while return to sport should be considered a multifactorial decision rather than the result of isolated imaging findings, tests or predefined timelines. Future prospective studies should determine which anatomical features provide clinically relevant prognostic information and develop validated calf-specific functional and return-to-sport outcomes.