# Gastrocnemius (calf) muscle tear - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Gastrocnemius Strain - StatPearls - NCBI Bookshelf (NBK534766) - https://www.ncbi.nlm.nih.gov/books/NBK534766/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD49.01 - condition scope only, no dose · MSF Essential Drugs 2024 - paracetamol (oral) · MSF Essential Drugs 2024 (ibuprofen oral monograph) - Verified date: 2026-08 ## Verified against - Gastrocnemius (calf) muscle tear - disease-level clinical article (gastrocnemius-tear-clinical.txt) - MSF Essential Drugs 2024 - paracetamol (oral) - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text GASTROCNEMIUS (CALF) MUSCLE TEAR Sources: Gastrocnemius Strain - StatPearls - NCBI Bookshelf (NBK534766) - https://www.ncbi.nlm.nih.gov/books/NBK534766/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD49.01 - condition scope only, no dose · MSF Essential Drugs 2024 - paracetamol (oral) · MSF Essential Drugs 2024 (ibuprofen oral monograph) Review status: REVIEWED against Gastrocnemius (calf) muscle tear - disease-level clinical article (gastrocnemius-tear-clinical.txt), MSF Essential Drugs 2024 - paracetamol (oral), MSF Essential Drugs 2024 (ibuprofen oral monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - A sudden pop or tearing feeling in the upper calf follows a forceful push-off such as sprinting or jumping - Patients struggle to bear weight and prefer walking on their toes, with pain worse on active plantarflexion or passive dorsiflexion SIGNS - what you find (3) - Exam shows swelling, bruising, and focal tenderness of the upper calf, sometimes a palpable gap in the muscle [bruising] - Patients have trouble performing a single calf raise on the affected side - The Thompson squeeze test stays negative, with normal plantar flexion on calf squeeze, unlike an Achilles rupture TESTS (1) - MRI is the gold-standard soft-tissue study but is reserved for cases where the diagnosis stays unclear IF NOT THIS - what else fits (7) - Plantaris strain is milder, with pain sitting more distally near the mid-Achilles rather than the upper calf - Soleus strain follows overuse from distance running, with deep calf pain worsened by knee flexion or dorsiflexion, as on hill running - Popliteal tendinopathy causes lateral knee or posterolateral calf pain worse on downhill running, tender at its femoral condyle origin - Popliteal artery entrapment gives claudication-like symptoms with repetitive ankle motion that eases with rest, and pulses drop on plantarflexion - Achilles tendinopathy causes gradually increasing pain 2 to 6 cm above the heel from overuse, unlike a sudden gastrocnemius tear - Chronic exertional compartment syndrome gives bilateral deep calf or shin pain in runners that resolves 10 to 20 minutes after stopping - DVT causes worsening calf pain and swelling usually without an injury history, with diffuse swelling and no focal tenderness Source StatPearls "Gastrocnemius Rupture" - disease-level clinical article Status traced to the source above Rx: Pain | Main treatment PAIN - choose one 1. PARACETAMOL [1st line] Adult 1 g (two 500 mg tablets) 3 or 4 times daily, to a maximum of 4 g in 24 hours. - Until the patient can walk without limping. Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg 3 or 4 times daily, to a maximum of 60 mg/kg in 24 hours. Child under 1 month: 10 mg/kg 3 or 4 times daily, to a maximum of 40 mg/kg in 24 hours. A single dose is capped at 500 mg because the top band of MSF's own weight table, 30 to under 50 kg, is one 500 mg tablet three times daily.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Paracetamol is the acetaminophen the article names - the two words are the same medicine. The article's initial treatment is rest until the patient can walk without limping, a walking boot if the pain is severe, heel lifts, ice for 20 minutes four times daily, and an NSAID or acetaminophen to help with the pain. It names the two drug classes and no amount, so the amounts are MSF's. Caution A calf that is tense and hurts out of all proportion to the examination is compartment syndrome and needs emergency surgical assessment; an analgesic that quietens it changes nothing. Never exceed 4 g in 24 hours in an adult, or 60 mg/kg in 24 hours in a child. MSF warns that paracetamol poisoning is severe - it causes hepatic cytolysis - and that the stated limits matter most in children and in older patients. MSF records no contra-indication in pregnancy or in breast-feeding, and names paracetamol as the analgesic of choice for a patient allergic to aspirin, one with a history of gastric trouble, a pregnant or breast-feeding woman, and children. Paracetamol has no anti-inflammatory action, so it eases the pain and does nothing for the swelling. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [1st line] Adult 200 to 400 mg 3 to 4 times daily as required, to a maximum of 1,200 mg in 24 hours. Take it with food and keep doses at least 4 hours apart. - A short course over the first days, with the ice and the rest. Peds 5-10 mg/kg/dose [child max 400 mg] (Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Choice Alternatives, and the article does not rank them - the order below is set here. The article offers "an NSAID or acetaminophen" as equals. Ibuprofen leads because a torn calf muscle swells and the anti-inflammatory acts on that too. Paracetamol is the choice for anyone an NSAID is barred in - peptic ulcer, kidney disease, asthma worsened by NSAIDs, anticoagulation, the third trimester. Source MSF Essential Drugs 2024 (ibuprofen oral monograph) Why Ibuprofen is the NSAID the article offers as the alternative to acetaminophen. The article's initial treatment is rest until the patient can walk without limping, a walking boot if the pain is severe, heel lifts, ice for 20 minutes four times daily, and an NSAID or acetaminophen to help with the pain. It names the two drug classes and no amount, so the amounts are MSF's. Caution Generalised calf swelling and worsening pain without a clear mechanical injury raises deep vein thrombosis, which the article carries both as a complication and as a differential. An NSAID does not make a swollen calf safe. A positive calf squeeze test or an inability to plantarflex points to an Achilles rupture and needs urgent orthopaedic referral. Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection. Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication. Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure. It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Sudden calf muscle tear during push-off ("tennis leg") or a related Achilles tendon injury; mild strains are managed conservatively with analgesia and rest, but a suspected Achilles rupture needs urgent orthopedic referral. - Refer, with advice Peds A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age. Source No dose - referral pathway, no medicine given in primary care Why Sudden calf muscle tear during push-off ("tennis leg") or a related Achilles tendon injury; mild strains are managed conservatively with analgesia and rest, but a suspected Achilles rupture needs urgent orthopedic referral. Caution Positive calf squeeze test / suspected Achilles rupture, inability to plantarflex the foot, calf swelling raising concern for DVT. The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral. RED FLAG - Acute Compartment Syndrome (tense muscle compartment, pain out of proportion to physical exam) is an urgent red flag requiring emergent surgical consultation. Deep Vein Thrombosis is a red flag, either as a complication or as a differential diagnosis (generalized calf swelling and worsening pain without focal mechanical injury). Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)