Your calf—located in the back of your leg just below the knee—is made up of three muscles: the gastrocnemius, soleus, and plantaris muscles.
The causes of calf pain can be highly variable including direct trauma, overuse, muscle and tendon ruptures, and blood clots. The symptoms can range from mild achiness and tightness to sudden inability to walk or bear weight.
The initial treatment of these injuries include rest, elevation, and compression. Heating pads can help relax muscle spasms. Stretching of the muscles of the lower leg can also help decrease muscle spasms. However, if the calf pain is accompanied any of these symptoms including warmth, redness, fevers, and or shortness of breath, you should consult a physician immediately to rule out a blood clot.
Deep venous thrombosis (DVT) if ignored can fragment and travel to the lungs, causing a pulmonary embolus (PE). In severe cases, these events can be fatal. So, don’t ignore the symptoms!
However, for routine strains of the calf muscles, SimpleTherapy can provide stretching and strengthening exercises to help minimize the spasm and return you to good function.
An injury to any of these can cause calf pain. But conditions that affect the blood vessels, nerves, or tissues that surround your calf muscles can be painful as well.
Calf pain can result from many different causes. Sometimes something as simple as overactivity causes muscle strain in the calf. Or dietary imbalances may cause cramping in the calf.
However, calf pain may be a symptom of more serious problems as well. Poor blood flow to the legs (peripheral vascular disease or PVD) may cause cramping in the calf while walking or when sitting with the legs elevated. A blood clot in the calf (deep vein thrombosis or DVT), a very serious problem, also produces pain in the calf.
Calf pain can also be the result of injuries, such as tearing of the calf muscle or tendonitis. In any case, it is not something that should be ignored. A foot and ankle surgeon should be seen for a thorough examination and diagnosis to determine whether the cause is due to a serious health problem, an injury or merely overuse. The cause of the calf pain will determine the proper treatment.
This article discusses the potential causes of your calf pain. It also includes strategies you can try to manage your symptoms and prevent muscle-related calf pain in the future.
What Is Calf Pain?
Calf pain is any feeling of discomfort in the fleshy tissue on the back side of the lower leg, from below the knee to above the ankle. Your calves are made up of muscles, tendons, ligaments, nerves and blood vessels, all of which are subject to injury, infection or other conditions that can be painful.
Calf pain may last briefly or be constant. It may affect your entire calf or only a localized area. Your pain may feel dull and achy, throbbing, piercing, or tingling. Pain-like sensations that are often described as pins-and-needles, prickling, or burning are called paresthesias. Calf pain may be simply irritating and uncomfortable or so debilitating that you can’t put weight on your leg or walk.
Calf pain can arise from a variety of conditions ranging from accidental trauma to nerve conditions. Calf pain in the absence of trauma or other symptoms is commonly due to a muscle cramp, also called a “charley horse.” However, there are more serious conditions that lead to calf pain, such as peripheral artery disease.
Calf pain can be due to deep vein thrombosis (a blood clot in the leg), which is a serious and life-threatening condition. The blood clot can break loose and cause a pulmonary embolism in the lung, a heart attack, or a stroke. If you, or someone you are with, are experiencing calf or leg pain after mild exercise or exertion, or if you are experiencing pain, swelling, redness, and warmth in the calf
Types of Calf Pain
Calf pain can manifest itself in various ways. It can happen at night-time or during the day; during strenuous activity or total rest. It may stay in your calf or radiate to your thigh, and you might also feel a tightening in the muscle, or experience swelling, redness, or hotness in the area. This pain can indicate a number of things, and seeing a doctor for a diagnosis should tell you what is causing the problem and what you can do to relieve it.
Calf pain can be broken up into two categories: pain that is related to the muscles, and pain that is not. Muscular pain often results from acute or chronic physical strain. These are the types of injuries that commonly happen in sports or other types of physical activity.
On the other hand, if you are having calf pain and you are not sure why, you may have an underlying condition that needs medical attention. Pain that is not muscle-related could be due to nerve damage, arterial disease, severe trauma, or something else.
What Other Symptoms Might Occur With Calf Pain?
What Other Symptoms Might Occur With Calf Pain?
Other symptoms may occur with calf pain depending on the underlying disease, disorder or condition. For example, a soft tissue infection or inflammation in the calf might be accompanied by redness or warmth in the area. Calf pain due to a pulled muscle may be associated with swelling from fluid buildup. Other symptoms that may accompany calf pain include:
- Burning feeling
- Bruising
- Flu-like symptoms (fatigue, fever, sore throat, headache, cough, and aches and pains)
- Joint pain
- Muscle spasms
- Numbness
- Reduced range of motion
- Skin bumps
- Skin discoloration, such as bruising
- Sleep disturbances
- Swelling
- Unexpected weight loss
- Varicose veins
Serious Symptoms That Might Indicate A Life-Threatening Condition
In some cases, calf pain may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have other serious symptoms, with or without calf pain, including:
- Change in consciousness or alertness; confusion
- Cold and pale leg, particularly one leg compared to the other
- Difficulty breathing, wheezing, or shortness of breath
- High fever (higher than 101 degrees Fahrenheit)
- Inability to walk or put weight on your leg
- Pain after walking or mild exertion that does not go away
- Pale or bluish skin (cyanosis)
- Popping sound at time of injury
- Red streaks around a tender area or lump
- Red, warm, and swollen calf or leg
- Weakness or lethargy
Causes of Calf Pain
Muscle Cramp
Muscle cramps are sudden, painful contractions of the muscles. They can be brief or last for several minutes at a time. Cramps are common, and they’re generally caused by exercising more than normal or doing new exercises.
Cramps can also be triggered by dehydration, muscle injuries, and mineral deficiencies. More serious causes of muscle cramps are:
- kidney failure
- hypothyroidism
- alcoholism
- diabetes
- severe peripheral vascular disease
In more severe cases, limited blood flow to parts of the body and other serious medical conditions can cause muscle cramps.
Gastrocnemius Strain
A medial gastrocnemius strain is a acute injury that happens when the calf muscle is abruptly overstretched. This causes small tears in the calf muscle fibers.
Gastrocnemius strains often happen during sports or exercise activities that involve sprints or jumps. It is one of the most common types of calf muscle strain.2
Some people hear a “pop” when the injury occurs, and you may not feel pain in the moment. Usually, pain sets in after you take a few steps, and it can be described as a sharp or tearing sensation.
If the strain is severe, there may be swelling and bruising. In some cases, the pain may be too intense to walk.
Arterial claudication
A person may experience calf pain due to narrowing or blockages in the arteries that supply blood flow to the legs. This is known as arterial claudication.
Arterial claudication may cause pain while walking, as this movement requires blood to flow to the lower legs.
If the blood has difficulty moving due to narrowing (claudication), a person may experience calf pain.
A person with arterial claudication will experience no discomfort at rest, but pain after a few minutes of walking.
Dropped Arches
Dropped or dysfunctional arches (flat feet) can happen as a result of the arches not forming properly or becoming stiff due to the overwhelming strain caused by walking on hard surfaces like concrete. Local inflammation of tissue in the foot is often known as plantar fasciitis – which we can treat by mobilising the joints in the feet and giving the correct advice on footwear and potentially orthotics.
Achilles Tendonitis
Achilles tendonitis is caused by overuse, strain, or stress on the Achilles tendon. Common symptoms include inflammation of the tendon, pain in the back of the leg, swelling, and limited range of motion when flexing your foot. Simple home treatments like R.I.C.E. (rest, ice, compress, elevate) can help.
If home treatment doesn’t work or your pain gets worse, it’s important to see a doctor.
Calf Muscle Contusion
A calf muscle contusion, otherwise known as a bruise, happens when blood vessels under the skin are torn or ruptured. As a result, the blood vessels leak into the muscle tissues.3
This type of injury often occurs after a person falls, bumps into something, or is struck on the calf. Typically, a contusion leads to skin discoloration, along with tenderness or severe pain. Swelling may also limit your ability to move as you normally would.
With rest and rehabilitation, blood beneath the skin will reabsorb into your body as the contusion heals. However, contusions can occasionally lead to a hematoma—a pool of blood under the skin.
Neurogenic Claudication
Neurogenic claudication occurs when the nerves that go to the legs are pinched, affecting their ability to communicate with the lower legs.
Neurogenic claudication is often due to a condition called spinal stenosis.This condition occurs when the bones in the spinal column narrow, placing extra pressure on the nerves. Sciatica is one example of neurogenic claudication.
In addition to calf pain, neurogenic claudication symptoms include:
pain while walking
pain after prolonged standing
pain that also occurs in the thighs, lower back, or buttocks
pain that usually improves when a person leans forward at the waist
A person may also experience calf pain from neurogenic claudication when at rest.
Ankle/Knee Tendinitis
This condition is particularly common in athletes, as the ankle and knee absorb force constantly during strenuous activity. You may get ankle or knee tendinitis as a result of weaker muscles in the legs, for example the hamstrings or thigh muscles, as this puts greater stress and strain on the knee and ankle.
Baker’s Cyst
Baker’s Cysts commonly occur from arthritis in the knee or from a sports injury, it is a form of swelling behind the knee. While this can originally cause pain in the knee, if a Baker’s Cyst ruptures this causes swelling and a sharp pain in the calf.
Sciatica
Sciatica is a result of issues with the sciatic nerve, which controls muscles in the lower leg and back of the knee. It can cause pain, numbness, and tingling in the lower back that can stretch down the leg to the calf and other muscles.
In more severe cases, surgery may be necessary to treat sciatica. Check out these six stretches for sciatica pain relief.
Plantaris Muscle Rupture
Plantaris muscle ruptures happen when a lot of body weight is suddenly placed on the ankle while the knee is extended. You may feel a sudden, snapping pain in the back of your leg when the injury occurs.6
Bruising, pain, and swelling may take a few minutes, hours, or even days to develop after the injury occurs. Some people may also have cramping in their calf muscle. Fortunately, this injury should also heal on its own.
Compartment Syndrome
Compartment syndrome is a painful condition that can occur in the calf muscle or in both legs, usually after a person has experienced a trauma or severe injury.
It occurs when excess blood or fluid builds up underneath a band of tough tissues in the body that cannot stretch very well. This fluid places extra pressure on the nerves and blood vessels in the lower leg, causing pain, swelling, numbness, and tingling.
Another form of compartment syndrome is chronic or exertional compartment syndrome. This type occurs when a person experiences pain while exercising.
Symptoms associated with chronic compartment syndrome include numbness, visible bulging or enlarging of muscles, or trouble moving the foot.
Shin Splints
Shin splints can, again, occur as a result of injury from exercise as a result of more intense weight bearing on the legs. Examples of intense weight bearing include; running on a hard surface, or rapidly increasing training distances over a short space of time. The pain can vary in severity from a dull ache to more severe pain during exercise and occurs over the shinbone.
Diabetic Peripheral Neuropathy
Diabetic peripheral neuropathy (DPN) is a form of nerve damage that affects the feet, legs, arms and hands. This condition is a common complication of diabetes resulting from overexposure to high blood sugar, genetic factors, or nerve inflammation. Other symptoms of DPN include:
- sharp pain
- muscle cramps
- muscle weakness
- loss of balance and coordination
- numbness
- impaired sensation (the reduced ability to feel pain or temperature changes)
Blood Clot
Blood clots can form in the deep veins of the leg—a condition known as deep vein thrombosis. This can cause swelling, redness, warmth, and a tender, cramping pain in the calf.
Certain conditions increase a person’s risk of developing a blood clot, such as:
- Increasing age
- Pregnancy
- Obesity
- Lack of physical activity
- Cancer
- Undergoing a recent surgical procedure
Plantar Fasciitis
Plantar fasciitis is a condition that affects the plantar fascia tissue located on the bottom of the foot.
If the calf muscles are too tight, a person may be more likely to experience plantar fascia because the calf muscles cannot support the foot.
The most common symptoms of plantar fasciitis are foot pain when waking and difficulty flexing the foot.
Deep Bein Thrombosis
Deep vein thrombosis (DVT) is the result of a blood clot forming in the deep vein in the arm or leg, including the calf. There are numerous factors and conditions that can cause DVT. Some include sitting for long periods of time, medication complications, and smoking.
Symptoms of DVT include:
visible veins in the affected area
swelling
leg tenderness
skin discoloration
feeling of warmth in the calf
You should see your doctor immediately if you develop symptoms of DVT.
Popliteal Artery Entrapment
Popliteal artery entrapment happens when the gastrocnemius muscle places pressure on the popliteal artery—an artery in the back of the leg and the knee. This can restrict blood flow in the legs.16
The condition may be congenital (present at birth) or it may develop over time. It is commonly seen in young athletes, as their popliteal artery becomes compressed while their body is still growing.16
The symptoms of popliteal artery entrapment can include cramping, tightness, and pain in the calf, particularly after a vigorous lower leg workout, such as cycling or running.17
Peripheral Arterial Disease and Claudication
Peripheral artery disease can reduce blood flow in the arteries of the lower legs, leading to claudication (cramping pain during activity). This is due to narrowed or blocked arteries in the mid-thigh or the knee.
With claudication, you may feel pain in your buttock, hip, thigh, calf, and/or foot upon walking short distances. Some people experience pain in their leg while lying in bed at night—this is a sign that the condition is getting worse.
Diagnosis
To diagnose your calf pain, a doctor will likely perform a physical exam and ask you about your medical history. They may also order imaging tests, such as an X-ray, ultrasound, or magnetic resonance imaging (MRI). Sometimes, blood tests are also needed.5
Medical History
Prior to your doctor’s visit, it’s a good idea to jot down a couple notes about your calf pain. You may write about when it started, what it feels like, and whether you have any other symptoms like numbness or swelling. These details will help your doctor pinpoint the cause.
In addition to asking about the specifics of your calf pain, your doctor will want to know if you have any health problems. Be sure to tell them about any recent injury or trauma you may have had.
Physical Examination
During the physical exam, your doctor will inspect and press on (palpate) your lower leg in order to look for signs of swelling, tenderness, warmth, and discoloration or redness. They may also check your reflexes and feel for your pulse in your leg, ankle, and foot.
Lastly, they will maneuver your foot, ankle, and knee to see how well you’re able to move it. They will likely perform other special tests if they suspect a certain diagnosis.
An example of a special test that doctors use to evaluate calf pain is the Thompson test.22
For this test, the patient lies flat on an exam table with their foot hanging over the edge. A doctor will then squeeze the patient’s calf muscle. If the patient’s toes do not flex downward when the calf is squeezed, the doctor may suspect an Achilles tendon rupture.
Blood Tests
In most instances, blood tests are not needed to diagnose calf pain.
That said, a D-dimer test may be ordered to help diagnose a blood clot or pulmonary embolism.23 D-dimers are fragments of proteins the body produces as it breaks blood clots down, so a positive test means there may be a blood clot in your body.
To check for a bone infection, a blood test may be used to measure erythrocyte sedimentation rate (ESR). A faster-than-normal ESR means that your immune system has triggered inflammation.
A blood test may also be used to measure levels of C-reactive protein (CRP)—a protein produced by the liver when there is inflammation in your body.
Imaging
When diagnosing calf pain, doctors may use various imaging tests. X-rays can reveal many types of abnormalities of the lower leg, ankle, or knee, particularly problems with bones and joints.
An ultrasound or MRI may be used to evaluate calf tendon injuries and tears. In some cases, imaging tests can also be used to check for blood clots.
If you doctor suspects a blood clot, they may order a vascular study to confirm the diagnosis. This type of ultrasound is used to check the blood flow in your veins and arteries.
How Is Calf Pain Treated?
In most cases, calf pain is caused by a muscle cramp or strain, both of which you can treat at home.
Tips to relieve calf pain
For a calf muscle pull (strain) or cramp, you may be able to improve healing time and relieve pain with these steps:
- Stop the activity that is causing pain and rest your leg.
- Apply an ice bag or frozen bag of vegetables on your calf for 15 to 20 minutes, several times a day. This will help reduce inflammation and swelling.
- Elevate your leg above the level of your heart (over the back of the couch, for example) when you are resting.
- Wrap an elastic bandage around your calf; loosen the bandage if it hurts. Compression will help limit swelling and provide support to the calf.
- Massage your calf gently to generate heat and relax the muscles and other soft tissues. You can also apply moist heat or soak in a warm bath.
- Take ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol) for pain relief.
- Take a magnesium supplement to help prevent cramps.
- Drink plenty of water to stay hydrated. This will help prevent muscle cramps.
If you have a severe muscle, tendon or ligament tear, you may need surgery to repair the damage, followed by physical therapy. If you have persistent muscle cramps, especially at night, your doctor may prescribe a muscle relaxer.
Stretches
Warming up by walking at a moderate pace before engaging in more intense exercise can help to prevent muscle strain injuries.
In addition to these measures, a person may also choose to do some gentle stretching to reduce muscle tightness after exercise.
A person should always check with their doctor before beginning a stretching routine to ensure the stretches will not aggravate an injury.
Useful stretches for calf pain include:
- Sitting calf stretch: Sit on the floor with the affected leg extended and the other leg bent towards you. Wrap an exercise band or towel around your foot, placing the ball of your foot at the center of the cloth/band. Pull the two ends towards you until you feel a little tension in your muscles and tendons. Hold for 5 seconds, then release. Repeat a few times on each leg, at least once a day until the area heals.
- Standing calf stretch: Put your hands on a chair or palms against a wall, about an arm’s length away. Keep one leg back, with your forward leg slightly bent. Both feet are flat on the floor. Slowly bend your forward knee and elbows, moving your hips towards the chair/wall until you feel a stretch in the rear calf. Hold for 30 to 60 seconds. Repeat a few times with each leg.
- Small (baby) steps: Take a step very slowly—one step should take a minute. Start from a slightly staggered position. Slowly, lift your back foot off the ground all at once, rather than pushing off with your toes as you normally would. Only lift it 2 to 3 inches. Slowly bring it forward and place it gently next to your other foot. Now repeat with the other foot. Repeat a few times on each side, a few times a day if possible.
Stretching after exercising may also help to prevent muscle tightness and discomfort.
Other Treatments
Treatment for calf pain not due to injuries depends on the cause:
- Degenerative causes: Doctors typically prescribe physical therapy for spinal or nerve entrapment causes of calf pain. In some cases, strengthening the muscles around the spine can correct body alignment and relieve pressure (compression) on the nerve or nerve root. For acute pain, your doctor may prescribe a short-term course of pain relievers. Steroid injections can calm inflammation.
- Deep vein thrombosis: For blood clots, doctors prescribe “clot-busting” drugs (thrombolytics), blood thinners (anticoagulants), and compression stockings. Surgery may be necessary to remove the clot.
- Infections: Doctors prescribe antibiotics to clear bacterial infections, such as cellulitis.
- Peripheral artery disease: Medications are a common treatment for PAD with leg pain. These include drugs to lower cholesterol and blood pressure, blood thinners to improve blood flow and prevent clots, and pain relievers. Lifestyle changes, including a heart-healthy diet, more physical activity, and not smoking can help PAD from getting worse.
- Varicose veins: The first-line treatment is self-care, such as compression stockings and more physical activity. Your doctor may recommend removing painful varicose veins with nonsurgical treatments.
Prevention
Here are a few tips that should help prevent calf pain:
- Stretch. One of the most important methods for preventing calf pain is stretching. Stretching before and after all workouts helps repair and strengthen the calf, thereby preventing future pain and injury. Make sure you have enough time to rest between workouts to help facilitate this muscle repair and growth.
- Stay hydrated. Staying hydrated is another key way to prevent calf pain. This is because dehydration directly contributes to muscle cramps. Check out seven other benefits of drinking enough water.
- Gradually increase exercise. It’s important when starting or increasing exercise to do it gradually. Increasing your activity level too abruptly can cause injury. Find an exercise plan online or work with a trainer.
