KLi'lllUCtAV TM*., HI,AMMtlS * 
HV WM. o. McOOXAl l>, M. 1>. 
NEW YOKK. 
In (bay's Anatomy (Philadelphia, 
i#51/) the plantaris muscle is sai<l to arise 
"from the lower part of Kite external bi- 
furcation of the lim a aspera and from the 
posterior ligament of t'hv knee joint.” 
1 hat "it forms a small fusiform belly 
about two inches in length, which ter- 
minatiin a long slender tendon, which 
crosses obliquely between the two mus- 
cle-. of the calf, and running along the 
inner bonder of the tendo-Achillis, is in- 
serted into tile posterior part of the os 
calcis. That “this muscle is occasion- 
ally double." That "it is sometimes 
wanting.” "(kcasionally its tendon is 
lost in the subcutaneous tissue, or in the 
internal annular ligament.” In the plate, 
however, the muscle is represented as 
being alxmt four inches long, 1 should 
judge, reaching from the origin of the 
gastrocnemius to about on a level with 
the inferior end of the oblique line of the 
tibia. 
In Rauber's Human Anatomy (fifth 
edition. Yol. I.), the plantaris is described 
as a slender muscle of varying relations, 
being sometimes wanting. He says that 
it originates from the eondvlus lateralis 
femoris and from the capsule of the knee 
joitit: that it crosses with a thin tendon, 
the direction of the gastrocnemius and 
soleus between them to the median bor- 
der of the tendo-Achillis. When it mav 
* Read before the New York County Homeo- 
pathic Medical Society. 2 
be merged in this tendon, go to the ankle 
joint and to the os calcis. 
Rauber also states that in the anthro- 
poid apes the tendon continues over the 
os calcis to the hollow of the foot, ter- 
minating in the plantar aponeurosis. 
Apparently rupture takes place at or 
near where the muscle goes over into 
tendon. 
Judging from the scant notice taken 
of the accident in medical literature it 
might be held to be infrequent. Yet this 
can hardly be the case, inasmuch as Jud- 
son and Terillon each report three cases. 
Hood referred to several. Powell and 
Morton one each, while I have met with 
four in all. On the other hand, Koenig, 
in his work upon “Special Surgery,” after 
stating that such an injury can happen, 
refers to a case reported by Nichols, of 
Boston, in confirmation, seemingly hav- 
ing had none of his own. 
The only notice of it that I can find in 
Park's Surgery being that it 'had occurred 
in lawn tennis. 
In Treves’ “System of Surgery” he re- 
fers to rupture of the muscles of the leg 
as being graphically characterized by the 
term used by the French, “coup de 
fouet,” and that is all. 
Rupture of the plantaris is the term 
used by the English-speaking people. 
The French style it “coup de fouet.” It 
has also been called the “lawn-tennis leg,” 
and, I believe, lately the “bicycle leg.” 
The French, according to Terillon, 
hold that “coup de fouet” may be due to 
rupture of tendinous, aponeurotic, mus- 
cular and vascular tissues in the calf of 
the leg. The English rather look upon 
the damage to the locomotor structures 
as being the principal lesion, the vascular 3 
fracture being inevitable, but not usually 
the most important, being rather inclined 
to consider the cases of rupture of dis- 
tended veins as hematomata. All ac- 
knowledge that the pre-existence of va- 
rices. particularly the deep-seated, is of 
serious import. The French refer to 
phlebitis as a sequence of wide extent, at 
times as being fraught with danger. 
In the Index Medicus from 1881 to 
i8</>, inclusive, I find the following 
named notices of the accident: 
Judson.— Rupture of the IMantaris. X. 
V. Med. Journal, iHHi. pp. 40-44. 
Terillon.—Varices profond, Coup de 
Fouet; in bulletin (ien. Ther., 1882, Cl I. 
P-.4-25- 
Lardier.—Coup de Fouet et Diastase 
Musculaire; Concours Med., Paris, 1883, 
p. 44f). 
Powell.— Lawn-Tennis Leg; London 
Lancet. 1883. No. II., p. 44. 
Hood.— Lawn-Tennis Leg, London 
Lancet; 1883, Xo. II., p. 728. 
Morton.— Lawn-Tennis Leg. Indian 
Med. (iaz.; 1887. p. 330.. XXII. Calcutta. 
In adition, in C. \V. Mansell Moulin s 
article on Sprains; Their Consequences 
and Treatment, in Woods’ Medical and 
Surgical Handbook, \ ol. II., Xo. 2. May, 
1880. p. 401-5. he takes up the considera- 
tion of lawn-tennis leg. 
It will be seen that l have made no at- 
tempt at an exhaustive search of medical 
literature for records of the affection. 
The affection varies in the severity of 
the symptoms. Judson reports one case 
where perfect cure was only reached 
after a duration of two and a half years. 
In another, two years elapsed. In the 
third, the patient still suffered sixteen 
months after the date of the accident. 4 
I erillon s cases all appear to have been 
of a grave nature; in fact, he refers to the 
lesion of vascular structures as being 
common, serious, and at times dangerous 
to a degree not even mentioned by the 
other writers upon the subject. Whereas, 
the cases reported by Powell, Hood, Mor- 
ton, and those noted by me, were surelv 
of a milder type, and in none of them was 
there any large implication of vascular 
structure, nor did the phlebitis of Terillon 
appear as a sequence. 
The symptoms of the accident are so 
peculiar that there is little trouble in mak- 
ing the diagnosis, provided the possibility 
of such damage is borne in mind. 
Mansell-Moulin says it happens in 
those who are no longer young. This is 
not invariable, however; that it is rare in 
the laboring classes; that in a large pro- 
portion of cases some evidences of gout 
may be found. Usually it happens when 
some sudden effort is made (generallv'i 
a pi onounced effort; but in other cases 
the merest slip suffices, one case happen- 
ing when walking on a level road. Sud- 
denly there is a sharp stab of pain in the 
calf of the leg. The English, when at- 
tempting to describe it, say that the suf- 
ferer nearly always thinks the leg has 
been hit bv a Hying stone. I he French 
refer to the sensation as being similar to 
that from the stroke of a whip. When 
severe, it is impossible to rest the weight 
of the body upon that limb. The pain of 
the onset usually is rapidly mitigated, but 
any attempt at walking, particularly 
when the body is over or in front of the 
foot, is out of the question, and many will 
not attempt such motion under any cir- 
cumstances. Visual examination now is 
fruitless. T alpation will disclose a ten- <k-r sjmM, which at times is also somewhat 
depressed; later this spot will become in- 
durated to some extent, and ecchymotic 
discoloration develops after a few days, 
which may extern! from the knee to the 
ankle. 
Jmlson says the diagnosis rests upon: 
I. The suddenness of the attack. 
II. The insignificance of the cause. 
III. The location of the trouble. 
IV. The pain, usually absent or slight 
wlren at rest, being excited by any mo- 
tion of the limb which distatrbes the mus- 
cles of the calf; ami, finally — the dispro- 
portion between the objective and the 
subjective symptoms. 
There are no records of post-mortem 
examinations; no dissection of the parts 
concerned in the injury being thus far 
re|>ortcd, probably none has ever been 
made, consequently the pathology must 
be soiiK'what conjectural. 
It appears probable that in the slighter 
cases the rupture of the plantaris muscle 
is the central lesion, but the vascular 
lesion is inevitable to-some extent, being 
of greater consequence when varices of 
t'he deep veins precede the accident. There 
still remain cases that can .only be ac- 
counted for by supposing that tendinous, 
aponeurotic and muscular structures out- 
si<le of the plantaris have been injured. 
Treat men t. 
The slighter cases do not really de- 
mand much treatment. Three of my 
cases were not subjected to any kind of 
mechanical appliances and they got well 
after a few weeks. But my own personal 
experience demonstrated to me that even 
in these great alleviation of the pain and 
material benefit in the wav of getting 
5 6 
about, can follow the application of what 
is called Hood’s Method of Treatment. 
Judson advises rest, fixation of the 
knee in a position of moderate flexion, 
and of the foot in a position of moderate 
extensin, together with the use of a high- 
heeled shoe later in the case. 
Terillon says that in his cases relief 
from pain was only to be obtained by 
lying down. Complete immobility in 
some cases. Compression by flannel 
bandages by and after the eighth day, and 
later, elastic bandages for a long time. It 
must be borne in mind that his cases all 
presented severe implication of the vas- 
cular structures, and called for more or 
less special management on account of 
the complicating phlebitis. 
Powell treated his cases by rest, flexion 
of the leg on thigh, extending the tarsus. 
This he kept up for four weeks. 
Hood, on the contrary, insists that rest, 
flexion at the knee and extension at the 
ankle, are precisely what should not be 
enforced, being liable, he holds, to favor 
repair with shortening of the damaged 
structures, which will render the patient 
prone to a recurrence of the tearing apart 
of the affected tissues. Hood’s method, 
as given by Moullin, is as follows: First, 
as soon as possible after the hurt, the pa- 
tient elevates the leg above the head for 
a matter of five minutes, in order to favor 
the flow of blood from the injured limb; 
then while in this position the limb is 
strapped with plaster strips one and one- 
half inches wide from two inches above 
the ankle to just about the thick part of 
the calf. When this is done the patient is 
directed to walk about, planting the heel 
firmly at each step. He insists that the 
patient may walk at once. On the third 7 
clay the plaster is to be re-applied. Four 
days later it is again changed. After that 
once a week will answer for the renewals. 
< )n the third day after the first strapping, 
the patient may go up and down stairs 
as usual. Hood says that on the first oc- 
casion very little pressure is desirable, 
later, more may be made. In bis article 
in the Lancet he suggests that the good 
•effects are due to forcing the surrounding 
structures to act like splints. 
In my own case the accident occurred 
when I was starting my cycle; the wheel 
was in the gutter; I was standing on the 
curbstone, certainly nine inches higher 
than the pavement upon which the wheels 
rested. 1 pushed off with my right foot, 
the left being on rhe pedal. I felt the 
rupture take place in the right calf with 
the usual sensation of being struck with 
a flying stone. I mention these particu- 
lars to show how slight the effort was. I 
had already started my wheel twice, once 
from the middle of the street. In walking 
home I found that I could walk fairly 
well, provided I did not get my body in 
front of the affected limb; in other words, 
I could take half a stride only with the 
right limb. I could take a longer stride 
if I walked entirely on my heel turning 
the foot far out. 
Hood's dressing was applied first with 
the old-fashioned diachylon plaster, but it 
was of little use, not holding well. Then 
the rubber adhesive plaster was used, and 
this was more efficient. But I soon dis- 
covered that what I needed was to get 
elastic compression of the limb. Simple 
support was not sufficient, though Hood 
implies this in his account where he says 
that “very little pressure is desirable, and 
mere laying on of the plaster will be suf- 8 
ficient.” In order t.o get this elastic com- 
pression the plaster was applied tightly in 
strips reaching from over and just to the 
outer side of the crest of the tibia, around 
the limb, over and just a little anterior to 
the shaft of the fibula, surrounding in this 
way about seven-eighths of the limb. 
Complete encircling of the limb gave a 
rigid compression that became unbear- 
able when the muscles of the calf played 
to and fro in walking. But I soon made 
another discovery, which was this: the 
straps, no matter how well applied, would 
yield in a few hours, and my compression 
would be gone. So to supplement this I 
had a flannel roller bandage applied from 
the tarsus to the spine of the tibia. This 
again was efficient for a time only in as- 
sisting the compressive action of the 
plaster, as the bandage would give and 
slip down when walking. Then I adopted 
a method of securing the bandage which 
maintained its efficiency for from two to 
three days at any rate. It consisted in 
this: The flannel roller was applied as 
usual to the tarsus and limb up to the 
lower fifth, after this each round of the 
bandage was secured by a strip of rubber 
plaster half an inch wide and three inches 
long applied to the external surface of the- 
bandage and to the skin of the leg above 
on each turn; this was continued up to the 
level of the spine of the tibia, where the 
end of the bandage was secured, and then 
strips of plaster were applied, after an 
imbricated fashion, over the upper and 
middle thirds of the leg on the anterior 
surface of the bandaged and strapped 
limb. Even this, however, only kept the 
apparatus in an efficient state for from 
forty-eight to seventy-two hours; in fact. 9 
I thin-k it would be profitable to re-apply 
tlx* whole dressing every second day. 
Hy brother suggested to me the trial 
of an elastic rubber roller bandage, but 
this did not appeal to me, as, without try- 
ing it, 1 feared that flu* compression 
would Ik* too forcible. 1 he use of the 
elastic stocking, similar to those used for 
varicose veins, was another suggestion, 
and I am inclined to think this worthy of 
experiment, though, of course, it could 
probably not be had for immediate use. 
In my case I never found a depression 
of the site of the injury, though later the 
spot was indurated and tender, the ecchy- 
motic discoloration extended from the 
ankle to the knee. The spontaneous pain 
was never of any account after.the first, 
while the pain from walking would be 
very severe. There was no edema of Me 
leg. and certainly but little swelling of the 
calf. I he lesion was mainly muscular, I 
feel sure, with only such vascular injury 
as necessarily was due to the tearing of 
the muscular substance. The site corre- 
sponded very well with that given for the 
lower end of the plantaris in (dray. Final- 
ly, Che amount of benefit obtained from 
the use of the appliances I have described, 
was well worth all the trouble I took to 
apply them. And I feel certain that fre- 
quent renewals of the straps ami band- 
ages are important points in practice, if 
the full amount of benefit is to be ob- 
tained. I used the apparatus for nearly 
four weeks, though I rode my wheel be- 
fore this time elapsed. 
In conclusion, I would urge that a 
sharp distinction should be drawn be- 
tween those cases Where the principal in- 
jury consists in the rupture of veins pre- 
viously varicose, on the one hand, from 10 
those where the principal damage is to 
a part of the locomotor apparatus, be it 
muscular, aponeurotic or tendinous, upon 
the other, the first variety being much 
more severe, evidently, and somewhat 
prone to be followed by complications, if 
we are to trust the accounts of the 
French. 
And in addition, while it may be proper 
to include muscular rupture of all varie- 
ties in the calf of the leg under the term 
“Coup de foue't,” the same license cannot 
be accorded to the use of the title of this 
paper. 
The expression, “rupture of the plan- 
taris muscle,” should be limited strictly 
to those accidents in which the injury oc- 
curs in the area in which this muscle is 
found. In my own cases the site of the 
damage was in the calf, rather to the inner 
side and at the junction of the upper and 
middle thirds of the leg, just Where the 
muscle goes over into the tendon, I 
should say. There is certainly no justifi- 
cation for speaking of rupture of the plan- 
taris when the damage is clearly not in 
the vicinity of the structure. 
In addition, I do not know that Hood’s 
method is appropriate when other mus- 
cles are torn, though Mansell-Moullin 
says he has found it to be as successful 
When a deep vein has been ruptured as 
when muscular fibres are plainly torn. 
While I am ready enough to explain 
the pain excited by moving the muscles 
of the calf as being due to the traction 
upon aird disturbance of the torn -mar- 
gins, yet I am quite unable to understand 
the comparative freedom from this dis- 
tress which follows the application of 
Hood’s dressing, and my modification 
of it, which is an improvement only inas- 11 
much as it maintains the compression 
longer and more effectively. 
Hood’s explanation, that it forces the 
surrounding parts to act in a splint-like 
fashion. d<x*s not appeal to me at all. and 
yet 1 am able to give nothing better. 
I wish to say, however, that there is 
no room for doubt as to the relief afforded 
by the apparatus, which is very great, and 
is perhaps only to be thoroughly appre- 
ciated by one who has suffered from the 
accident. 
1 wore it for a month, and at the end 
of that time, on taking it off. pain could 
be excited by certain motions of the calf 
muscle;.. 
177 W. I’OKTY-KOURTH StKKKT. 
Surgical Kka, 
•Chicago. 
January, 1898.