Soleus Trigger Points

Introduction

The soleus is a deep calf muscle responsible for ankle plantarflexion and postural stability. When trigger points develop in this muscle, they can cause heel pain, calf tightness, and Achilles discomfort, often mimicking Achilles tendinitis, plantar fasciitis, or deep vein thrombosis (DVT).

Name and Area

  • Name: Soleus

  • Area: Located in the posterior lower leg, running from the tibia and fibula to the Achilles tendon and calcaneus (heel bone).

Indications

Soleus trigger points may contribute to:

  • Pain in the calf and Achilles tendon (mistaken for Achilles tendinitis or calf strain)

  • Pain that extends to the heel (can mimic plantar fasciitis or heel spurs)

  • Tightness or cramping in the calf after walking, running, or standing

  • Pain when pressing on the Achilles tendon or lower calf (common in runners and hikers)

  • Weakness in pushing off the toes (difficulty running, jumping, or walking up stairs)

  • Pain that worsens with prolonged standing or wearing unsupportive shoes

Pain from this muscle is often mistaken for Achilles tendinitis, plantar fasciitis, or nerve compression.

Muscle Action

  • Plantarflexes the Ankle: Points the foot downward, essential for walking, running, and jumping.

  • Stabilizes the Lower Leg: Works with the gastrocnemius to maintain balance and support posture.

The soleus is crucial for ankle mobility, postural endurance, and lower limb function.

Signs and Symptoms

Individuals with soleus trigger points often report:

  • Deep, aching pain in the calf that feels like a "tight band" or cramps

  • Pain that radiates to the heel and arch (can resemble plantar fasciitis or Achilles pain)

  • Calf tightness that worsens after prolonged standing or running

  • Pain or fatigue in the lower leg that feels like "walking on a stiff ankle"

  • Pain that worsens in the morning or after rest (similar to plantar fasciitis symptoms)

  • Difficulty standing on tiptoes or pushing off while walking

Pain worsens with excessive walking, prolonged standing, or sudden high-impact activities.

Perpetuating Factors

Common causes of soleus trigger points include:

  • Running or sprinting without proper warm-up (common in marathoners, sprinters, and hikers)

  • Wearing high heels or unsupportive shoes (forces the soleus to work harder to stabilize the ankle and foot)

  • Excessive barefoot walking on hard surfaces (increases strain on the calf and Achilles tendon)

  • Tight hamstrings or weak glutes (can lead to overuse of the soleus for stability and posture)

  • Prolonged standing without movement (common in retail, hospitality, and healthcare workers)

Trigger Point Referral Pattern

Trigger points in the soleus refer pain to:

  • The calf and Achilles tendon (Can Mimic Achilles Tendinitis or Calf Strain)

  • The heel and plantar arch (Mistaken for Plantar Fasciitis or Heel Spurs)

  • The posterior knee (Can Resemble Hamstring Tightness or Popliteus Dysfunction)

Pain from this muscle is often confused with Achilles tendinitis, nerve entrapment, or foot dysfunction.

Differential Diagnosis

Soleus trigger points may be mistaken for:

  • Achilles tendinitis (pain and stiffness in the Achilles tendon, worsens with activity or morning steps)

  • Plantar fasciitis (heel and arch pain, worse in the morning or after prolonged standing)

  • Deep vein thrombosis (DVT) (calf pain and swelling, requires immediate medical attention)

  • Shin splints (pain along the front of the lower leg, often due to overuse in runners and athletes)

  • Tarsal tunnel syndrome (burning or tingling pain in the ankle and foot, similar to nerve compression)

A thorough lower leg, ankle, and foot examination is necessary to rule out these conditions.

Associated Trigger Points

Soleus trigger points often co-exist with:

  • Gastrocnemius (calf and Achilles pain, affects ankle stability and running mechanics)

  • Tibialis posterior (inner ankle and foot pain, affects arch support and stability)

  • Quadratus plantae (heel and arch pain, can resemble plantar fasciitis or foot cramps)

  • Peroneus longus and brevis (outer foot and ankle pain, can affect balance and gait)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Soleus Posterior tibia and fibula Achilles tendon, calcaneus (heel bone) Tibial nerve (S1–S2)

The soleus is innervated by the tibial nerve, which also controls ankle function and lower leg stabilization.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the posterior lower leg and Achilles tendon.

  • Resisted Plantarflexion Testing: Assess pain and weakness when pushing the foot downward against resistance.

  • Gait Analysis: Look for foot instability, excessive heel strike, or altered stride mechanics.

  • Ankle and Achilles Stability Testing: Rule out ligament sprains, Achilles injuries, or nerve compression.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the soleus, reducing calf tightness and improving ankle function.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots along the posterior lower leg and Achilles tendon.

  • Massage Therapy: Helps improve circulation and reduce lower leg muscle tension.

Stretching

  • Soleus Stretch Against a Wall: Bend the knee while pressing the heel down to target the deeper calf muscle.

  • Seated Calf Stretch With a Towel: Helps lengthen the soleus and Achilles tendon.

Strengthening Exercises

  • Seated Calf Raises: Strengthens the soleus while keeping the knee bent to isolate the deeper muscle fibers.

  • Single-Leg Balance Drills: Improves ankle proprioception and reduces foot instability.

  • Eccentric Heel Drops: Helps improve flexibility and prevent Achilles-related dysfunction.

Postural and Footwear Adjustments

  • Avoid wearing high heels for long periods (prevents excessive strain on the Achilles and calf muscles)

  • Use proper running shoes with heel support (prevents overuse of the soleus and peroneal muscles)

  • Gradually increase running or jumping intensity (prevents sudden overuse of the soleus)

Conclusion

The soleus plays a crucial role in ankle function, postural stability, and running mechanics, but trigger points in this muscle can cause significant calf, Achilles, and heel pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic lower leg dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.