Soleus

The Soleus is a superficial posterior muscle of the leg.

Anatomical Attachments:

• Origin: Laterally it attaches to the head and the superior 1/3 of the fibula. Medially it attaches to the middle 1/3 of the medial border of the tibia as well as the interosseous membrane.
• Insertion: Attaches into the calcaneus via the Achilles tendon.

Action: Plantar flexes the foot.

Synergist: Gastrocnemius, Tibialis posterior, Peroneus longus and brevis.

Antagonist: Tibialis anterior, Extensor digitorum longus and Peroneus tertius.

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Nerve Supply: Tibial nerve (S1, S2).

Nerve Entrapment: Entraps the tibial nerve.

Vascular supply: Posterior tibial, peroneal and popliteal artery.

Vascular entrapment: Entraps the popliteal vein when the leg is extended and the foot is dorsiflexed. It has the potential to entrap the popliteal neurovascular bundle and the posterior tibial veins.

• Primary: TrP 1 –refers to the plantar surface of the heel and to the distal end of the Achilles tendon; TrP2 – refers to the medial lateral aspect of the tibia with a spill over into the calf; TrP 3 – refers ipsilateral to the sacroiliac joint region with a similar spill over patterns of TrP 1; TrP 4 – According to Travell and Simons, there is a seldom observed 4th TrP in the Soleus, it is located in the posterior medial aspect of the calf. It refers pain to the ipsilateral Temporomandibular joint and mandible, thus making this TrP referral very bewildering. Malocclusion has also been attributed to this 4th trigger.
• Satellite or associated triggers: Gastrocnemius, Tibialis posterior, extensor digitorum longus, Peroneus tertius, Extensor hallucis longus.

	TrP 1	TrP 2	TrP 3	TrP 4

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Trigger Point Signs and Symptoms: Pain and tenderness to the heel, the inability to bear weight on the heel, calf and foot pain, edema in the foot and ankle, possible jaw pain with malocclusion.

Trigger Point Activating and Perpetuating Factors: Antalgic or compensatory gait, lower limb or pelvic inequality, sudden cooling of the muscle, mechanical overload or strain (which is frequently observed when an individual looses traction while either walking or running on the balls of their feet), neurovascular compression (as a result of wearing socks which have tight bands or garters). The persistent wearing of high heel shoes perpetuates triggers in both the Soleus and the Gastrocnemius.

Differential Diagnosis: Degenerative disc disease, (Segmental, Subluxation, Somatic dysfunction) L5 S1 or S2 radiculopathy, Sciatica (Hip rotator and Pelvic floor dysfunctions – Genital urinary and/or gynecological disease), Osteocarcinoma, Sacral shear, Intervertebral Stenosis, Peripheral vascular disease (PVD)-Intermittent claudication, Thrombophlebitis, Deep vein thrombosis (DVT), Superficial vascular thrombosis (SVT), Varicose veins, Nocturnal cramping, Tennis leg, Post exercise soreness, Posterior compartment syndrome, Buckling knee syndrome, Dislocation/Subluxation of knee, Heel spur, Posteromedial Shin splint, Bruised periosteum of the tibia, Bone fracture, Bone cancer, muscle strain, Popliteal (Baker’s) cyst, Rupture Achilles tendon, Achilles tendinitis, Rheumatoid arthritis, Osteoarthritis, Retrocalcaneal bursitis, Plantar fasciitis, Pes cavus, Pes Planus Plantars wart, Bone spur, Temporomandibular joint Dysfunction (TMD), Fractured tooth syndrome, Periapical infection, Trigeminal neuralgia (Tic Douloureux), Tetanus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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