OpenHealth Q&A

Seeking Guidance for Persistent Calf Pain Since 2023

Hello, everyone, I am a 31-year-old female, standing at 5 feet 3 inches and weighing 134 pounds. In August 2023, I started experiencing calf pain that seems to stem from Achilles tendonitis, triggered by running. This discomfort has persisted continuously since then. I have always maintained an active lifestyle for over a decade, primarily focusing on lifting weights and running. I have consulted with podiatrists on two occasions. They have suggested the option of muscle lengthening surgery if my condition fails to improve. Here's what I have undergone: - Attended physical therapy sessions twice, which were disrupted when I received a diagnosis related to connective tissue. - Engaged in Graston therapy and utilized heel orthotics. - Frequently wear Hokas for added support. My diagnosis indicated that I have shortened muscles and high arches, making me mechanically predisposed to issues. Additionally, I have had a flare-up of plantar fasciitis. While deep tissue massage offers temporary relief, the pain invariably returns, and I tend to feel it every day. I underwent an EMG, where the motor conduction tests returned normal results for all four nerves assessed: right and left peroneal nerves (EDB) and right and left tibial nerves (AH). The sensory conduction tests were also normal for the two nerves tested (right and left sural at the ankle/calf). The F wave study yielded normal results as well. However, the needle EMG revealed abnormal results across all six tested muscles, primarily indicating abnormalities in the left and right tibialis anterior and medial gastrocnemius, along with the left and right vastus lateralis. The findings showed increased complex motor unit potentials and slightly early motor unit recruitment, which may suggest a myopathic process, though no abnormal spontaneous activity was noted, as would typically occur in cases of myositis. A clinical correlation is warranted, particularly since these findings can arise in treated myositis. Currently, my physical therapist suspects I may be experiencing central sensitization and neural tension alongside chronic pain. They recommend only graded exercise at this time. The pain I experience feels deeply rooted, primarily affecting my calf muscles, with the Achilles becoming painful especially after physical exertion. Regarding my medical history, I've had a series of unusual symptoms, including high blood pressure and esophagitis. After my mother was diagnosed with rheumatoid arthritis, I was identified with undifferentiated connective tissue disease in September 2024, showing markers for lupus and scleroderma, though physical signs of scleroderma are absent and I exhibit more signs consistent with lupus. A rheumatologist confirmed that the creatine kinase levels do not indicate active muscle disease. I am currently taking the following medications: - Hydroxychloroquine - CellCept 1000 mg - Omeprazole 20 mg - Escitalopram 20 mg All routine tests, including ESR and CRP, remain within normal limits—indicating no systemic inflammation. My inquiry is this: If my lab results are normal for muscle disease, could my persistent issue be linked to mechanical tendon or fascia problems, such as delayed healing, adhesions, or tendinopathy, rather than an actual muscle disease? Would it be advisable to pursue MRI or ultrasound imaging, or consider treatments like PRP or shockwave therapy if conservative approaches continue to fall short? I have a follow-up appointment with a neurologist in November for another EMG and potentially further evaluations due to some neurological symptoms, which I hope will help rule out other diagnoses alongside my rheumatic condition.

Answers (1)

8/1/2025, 2:11:00 PM

OpenHealth AI

Thank you for sharing the detailed background regarding your persistent calf pain, a complex issue given your history with Achilles tendonitis, connective tissue disease, and myopathic findings. Let’s break down your situation and explore actionable steps to help alleviate your symptoms and clarify the underlying issues.

Main Points:

1. Your calf pain is likely influenced by mechanical factors and possibly exacerbated by a combination of structural issues and chronic pain syndromes.
2. Further imaging studies like MRI or ultrasound may be beneficial to evaluate soft tissue integrity.
3. Exploring advanced treatment options (like PRP or shockwave therapy) could be considered if conservative methods continue to be ineffective.

Explanation:

• With your background of high arches and shortened muscles, it's normal to have mechanical imbalances leading to pain in the Achilles and calf areas. Tendon issues often take longer to heal, and the presence of connective tissue disease can complicate recovery.
• Your lab results suggest that a significant muscle disease is less likely; thus, addressing the mechanical and structural aspects may be key.
• Central sensitization can cause a heightened pain response, making it crucial to approach your situation holistically and patiently.

Next Steps:

1. Consider Imaging: Speak to your healthcare provider about the possibility of getting an MRI or ultrasound. These tests can provide clarity on any tendon or fascial issues and help identify any tears, inflammations, or structural problems that may need targeted treatment.

2. Evaluate Advanced Therapies:

   • If conservative approaches like physical therapy and orthotic use do not yield improvement, discuss options such as:
     • Platelet-Rich Plasma (PRP) Therapy: This can promote healing in the tendon.
     • Shockwave Therapy: Often used for chronic tendon issues, it may help stimulate healing.

3. Continue Graded Exercise: Follow your physical therapist's recommendations. Graded exercise can help improve function without exacerbating pain. Consider activities low in impact, like swimming or cycling, which reduce strain on your calves.

4. Pain Management Techniques: Incorporate gentle stretching, ice application after activity, and possibly over-the-counter anti-inflammatory medication (if appropriate) to relieve discomfort. Gentle massage may also help with muscle tension.

5. Follow-Up Care: Stay engaged with your medical team, particularly with your neurologist. Documenting any new symptoms can provide valuable insights during consultations.

Remember, recovery is often a gradual process that might require ongoing adjustments. Your proactive approach, including managing your existing health conditions, will be vital in navigating these challenges effectively. Please reach out if you need further support or guidance on this journey.