21/11/2020 Soleus - Physiopedia

Soleus
Original Editor Aarti Sareen (/User:Aarti_Sareen)

Top Contributors - Aarti Sareen (/User:Aarti_Sareen), Kim Jackson (/User:Kim_Jackson), Evan Thomas
(/User:Evan_Thomas), Vanessa Rhule (/User:Vanessa_Rhule) and Richard Benes (/User:Richard_Benes)

Contents
1 Introduction
2 Anatomy
2.1 Origin
2.2 Insertion
2.3 Action
2.4 Nerve supply
2.5 Synergists
2.6 Antagonists
2.7 Blood supply
3 Function
4 Palpation
5 Accessory soleus muscle (ASM)
6 Pathology
6.1 Strain/Rupture
6.2 Soleus Syndrome
7 References

Introduction
Located in superficial posterior compartment of the leg Soleus is a powerfull
lower limb muscle which along with gastronemius and plantaris forms the calf
muscle or triceps surae. It runs from back of knee to the ankle and is
multipennate.

Anatomy
Origin
posterior surface of the head and upper 1/3 of the shaft of the fibula;
middle 1/3 of the medial border of the tibia, tendinous arch between tibia
and fibula.

Insertion
Into calcaneus with gastrocnemius by way of achilles tendon (/File:Soleus_3.jpg)

Action
Plantar flexion of the foot at the ankle;
Reversed origin insertion action: when standing, the calcanius becomes the fixed origin of the muscle;
Soleus muslce stabilizes the tibia on the calcaneus limiting forward sway.

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Nerve supply
Tibial nerve, L4, L5, S1 , S2

Synergists
Gastrocnemius (/Gastrocnemius), Plantaris, Tibialis posterior, Peroneus longus and Brevis, FHL and FDL.

Antagonists
Tibialis anterior

Blood supply
Blood supply of the soleus muscle is from peroneal artery proximally and the posterior tibial artery
distally;
Muscle has a mixed blood supply;
Vascular supply of the soleus is from popliteal, posterior tibial, & peroneal vascular pedicles to the
proximal muscle, peroneal pedicles to distal lateral belly, and segmental posterior tibial pedicles to
distal medial belly;
With distal pedicles from the posterior tibial artery ligated & based on proximal pedicles from the
posterior tibial and peroneal arteries, muscle can be transposed medially or laterally to cover defects
in middle third of the leg;
Proximal vasculature arises directly from the popliteal vessels and can reliably carry all but the distal 4
to 5 cm of the muscle;
Intramuscularly, vasculature of the soleus divides into a bipenniform segmental pattern;
w/ this vascular pattern, either half of the soleus muscle can be used, leaving a functional hemisoleus
muscle intact

Function
Soleus has two major functions:

To act as skeletal muscle: Along with other calf muscle it is powerfull plantarflexor and  have major
contribution  in running,walking and dancing.In the seated calf raise (knees flexed approximately 90º),
the gastrocnemius are virtually inactive while the load is borne almost entirely by the soleus. In
moderate force, the soleus is preferentially activated in the concentric phase, whereas the
gastrocnemius is preferentially activated in the eccentric phase [1].Human soleus muscle have majority
of slow twitch fibers.Human soleus fiber composition is quite variable, containing between 60 and
100% slow fibers.[2][3][4].

To act as muscle pump: along with other calf muscles it is known as peripheral heart as in uprite
posture it enhance pumping the venous blood back into heart from periphery

Palpation

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Accessory soleus muscle (ASM)

It is present in 0.7 to 5.5% of humans.[5]It is usually observed during the second or third decade of life and
is more commonly seen in females than males at a ratio of 2:1. It is mostly unilateral.[6][7][8][9][10][11]. This
supernumerary muscle is located under the gastrocnemius muscle, in the posterior upper third of the
fibula, in the oblique soleus line, between the fibular head and the posterior part of the tibia. From its
origin, the ASM runs anteriorly and medially until it reaches the Achilles tendon.[12]

       (/File:ASM.jpg)       

(/File:ASM2.jpg)      

Depending upon its insertion it is of 5 types, or in other words it can origninate from 5 sites

Achilles tendon
Upper calcaneus region
Insertion in the upper calcaneus,
Medial calcaneus region,
Medial part of the calcaneus
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Sometimes it is impossible to precisely identify the ASM origin and insertion, since the MRI fails to show
details, depending on the slices.[13]Itmay cause pain on exercise. One may suspect a soft-tissue tumor,
such as lipoma, hemangioma, and even sarcoma, but the anomalous muscle has a typical appearance on
plain radiographs, and the appearance on computed tomography is diagnostic. If the patient is
asymptomatic, no therapy is required, but if pain or other discomfort is provoked by exercise, exploration
with fasciotomy or excision of the accessory muscle is recommended, as was done in six of our eleven
patients who were seen between 1968 and 1985.[14]

Pathology
Strain/Rupture
Full or partial rupture of the soleus muscle usually occurs when the calf muscle becomes stretched while
it is contracting (eccentric contraction). Partial ruptures represent the majority of the ruptures. The rupture
occurs in many instances at the point of attachment of the soleus muscle to the Achilles tendon, which
will often trigger an inflammation of the Achilles tendon as a result of the soleus rupture.

Symptoms: Pain when activating the calf muscle (running and jumping), when applying pressure on the
Achilles tendon approx. 4 cm. above the anchor point on the heel bone or higher up in the calf muscle,
and when stretching the tendon. Walking on tip-toe will aggravate the pain.
In all cases when there is a sense of a "crack", or sudden shooting pains in the Achilles tendon, medical
attention should be sought as soon as possible. Ultrasound scanning or MRI examination is used to
advantage when making the diagnosis, as even full ruptures can easily be overlooked by normal clinical
examination. [15]

Further, about the soleus and calf strain can be read here (http://www.physio-pedia.com/Calf_Strain)

Whenever there occurs calf strain and the soleus is the muscle affected then there occur usually the
medial or lateral pain i.e along the soleus fibres. And when the pain is in the bulk of the calf muscle then
the gastrocnemius is the muscle affected,but, mostly both the muscles are affected together.

Soleus Syndrome
Another cause of medial pain (posteriomedial aspect of ankle) just above the medial malleous is the
soleus syndrome.[16] It occurs because of abnormal sliping of soleus muscle from its normal origin site
and is similar to exertional campartment syndrome and commaly seen in dancers and athlets. Respond
well to conservative treatment and if not then rarely fasciotomy of the soleus insertion may be required.[17]

References
1. A Nardone, C Romanò,M Schieppati.Selective recruitment of high-threshold human motor units
during voluntary isotonic lengthening of active muscles.J Physiol. 1989 February; 409: 451–471.
2. Ariano MA, Armstrong RB, Edgerton VR (January 1973). "Hindlimb muscle fiber populations of five
mammals". The Journal of Histochemistry and Cytochemistry 21 (1): 51–5.
3. Burke RE, Levine DN, Salcman M, Tsairis P (May 1974). "Motor units in cat soleus muscle:
physiological, histochemical and morphological characteristics". The Journal of Physiology 238 (3):
503–14.
4. Gollnick PD, Sjödin B, Karlsson J, Jansson E, Saltin B (April 1974). "Human soleus muscle: a
comparison of fiber composition and enzyme activities with other leg muscles". Pflügers Archiv 348
(3): 247–55
5. Sookur PA, Naraghi AM, Bleakney RR, Jalan R, Chan O, White LM. Accessorymuscles: anatomy,
symptoms and radiology evaluation. Radiographics. 2008;28(2):481-99.

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6. Crespo E, Minguez MF, Gascó J, Silvestre A, Jolín T, et al. Músculo sóleo accesorio como diagnóstico
diferencial de un tumor de partes blandas del tobillo. Acta Ortop Castellano-Manch. 2004;(5):37-41.
7. Romanus B, Lindahl S, Sterner B. Accessory soleus muscle. A clinical and radiographic presentation
of eleven cases. J Bone Joint Surg Am. 1986; 68(5):731-4.
8. Salomão O, Carvalho Junior AE, Fernandes TD, Romano D, Adachi PP, Sampaio Neto R. Músculo
solear acessório: aspectos clínicos e achados cirúrgicos. Rev Bras Ortop. 1994;29(4):251-5.
9. Leswick DA, Chow V, Stoneham GW. Resident's corner. Can Assoc Radiol J. 2003;54(5):313-5.
10. Featherstone T. MRI diagnosis of accessory soleus muscle strain. Br J Sports Med. 1995;29(4):277-8.
11. Doda N, Peh WC, Chawla A. Symptomatic accessory soleus muscle: diagnosis and follow-up on
magnetic resonance imaging. Br J Radiol. 2006;79(946):e129-32.
12. Flavio Belmont Del Nero; Cristiane Regina Ruiz; Roberto Aliaga Junior.The presence of accessory
soleous muscle in humans.Einstein (São Paulo) vol.10 no.1 São Paulo Jan./Mar. 2012.
13. Flavio Belmont Del Nero; Cristiane Regina Ruiz; Roberto Aliaga Junior.The presence of accessory
soleous muscle in humans.Einstein (São Paulo) vol.10 no.1 São Paulo Jan./Mar. 2012.
14. Romanus B, Lindahl S, Stener B.Accessory soleus muscle. A clinical and radiographic presentation of
eleven cases.J Bone Joint Surg Am. 1986 Jun;68(5):731-4.
15. citated from (sportnetdoc.com/foot-achilles/rupture-of-the-soleus-muscle) citated on august 31,2013.
16. Michael RH, Holder LE: The soleus syndrome. Am J Sports Med 1985; 13:87.
17. David A.Porter,Lew C.Schow.Baxter's Foot and Ankle in Sports.2nd Edition.Mosby Publication.

Categories (/Special:Categories): Anatomy (/Category:Anatomy) Muscles (/Category:Muscles)

Ankle (/Category:Ankle) Musculoskeletal/Orthopaedics (/Category:Musculoskeletal/Orthopaedics)
Ankle - Anatomy (/Category:Ankle_-_Anatomy) Ankle - Muscles (/Category:Ankle_-_Muscles)

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