World Cup 2026: Why is Christian Pulisic's ankle injury a complication? Experts explain

Calf injuries have become a hot topic of discussion at the 2026 World Cup — particularly the left calf of Team USA forward Christian Pulisic. The 27-year-old was substituted at half-time in the USA's opener against Peru. After that 4–1 win, head coach Mauricio Pochettino said, "He started to feel tight from the kick ('kick') in the leg; we changed him as a precaution. No big problem, hopefully he'll be ready for the next match." But Pulisic did not play in the second group game against Australia on Friday. However, Pochettino was optimistic that "the situation is good. He will soon be ready for the test again and be part of the team."

He returned to full-team training on Monday after a few days of controlled training with non-load-bearing gym, resistance and light ball work. The USA's next match is against Turkey on Thursday.

Not only Pulisic, but other big names are also struggling with ankle problems. Neymar is yet to feature for Brazil; England defender Dino Livramento has been ruled out of the World Cup.

Why are ankle injuries so complicated? Sports medicine experts Helen van Campen and Dominique Ray explain:

• The calf 'complex' is made up of three muscles: gastrocnemius, soleus, plantaris. They absorb, transfer and generate force through the Achilles tendon. It is an even more complex structure as there is an internal fiber-structure called 'aponeurosis' within the muscles.

• Running, jumping, acceleration/deceleration, steering—foot first touch on anything; The Achilles-foot complex can carry a force equal to 12 times body weight. If any part of the system 'breaks down', however, the force will shift to other chains, increasing the risk of injury and decreasing efficiency.

• Injuries can range from minor myofascial 'strain' to whole fiber tears. The muscle-bone attachment sheaths (tendons) or aponeurosis leading into the muscle may also be torn.

• A slow progression of injury symptoms is common in the calf, especially the soleus muscle. Because the soleus is made of 'slow-twitch' fibers, it works tirelessly throughout the 90-minute match; So injury is possible when the exertion-fatigue imbalance is out of balance.

• Atrophy limited to the muscular 'muscle belly' heals quickly; But if the central tendon/aponeurosis is involved the recovery time will be longer. Injury grades from Grade 1 to Grade 4 (complete tear): Grade 1 can be reversed in about 10 days; It may take up to 3 months if there is a long stretch up to the aponeurosis/tendon.

• In “blow” contusion type injuries, muscle fiber or fascia tear, internal bleeding (hematoma) may occur. Inflammation—congestion causes muscle dysfunction in the entire complex and decreases performance; A quick return may increase the risk of further bleeding/swelling.

Initial treatment:

• RICE procedure — rest, ice, compression, elevation — can help control bleeding and reduce pain. Cryotherapy may be used if needed.

• After bleeding has stopped, slow walking, muscle-specific movements will facilitate hematoma absorption.

• Restore normal muscle function through manual therapy, gradual strength training, electro-muscular stimulation.

Expert opinion on Pulisic status:

• A hematoma may have developed due to a 'kick' on the left leg. Early proper compression and control of bleeding may result in rapid recovery. But if the hematoma is not completely resolved by the time of the next competition, the performance of the leg will be affected.

Risk of Reinjury:

• Reinjury is always possible after soft tissue healing; A bit more especially if the tendon/aponeurosis is involved. Many factors such as age, previous injury history, injury location, and the athlete's flow-body dynamics determine the risk of re-injury. Intramuscular tendon injuries have a high recovery rate; Less than just myofascial injuries.

As the U.S.'s next match against Turkey approaches, Pulisic's readiness will be determined by his hemorrhage-inflammation control, pain response, and strength improvement. As coach Mauricio Pochettino says, "feelings are good" and he could be back in the squad soon.