Causes of Calf Pain and When to Worry

There are many different causes of calf pain. It may be directly related to your calf muscles—including the inner gastrocnemius and outer soleus muscles—or the tendons, bones, nerves, and blood vessels supporting and serving the calf.

The most common causes of calf pain are relatively harmless and readily treatable. Others may be serious and harder to treat, so it is important not to ignore calf pain if it is severe, persistent, or unresolvable with conservative treatment.

Signs to Seek Medical Care

If you're not sure what is causing your calf pain, you should contact your healthcare provider. This is especially true if the pain is persistent, severe, or worsening.

Some signs you should see a healthcare provider include:

• Inability to walk comfortably on the affected side
• An injury that causes deformity of the lower leg
• Calf pain that occurs at night or while resting
• Calf pain that persists beyond a few days
• Swelling of the calf or ankle joint area
• Signs of an infection, including fever, redness, and warmth
• Any other unusual symptom

Treatment depends entirely on the cause of the problem, and some conditions that cause calf pain can easily be confused with others. Getting a proper diagnosis can ensure you get the treatment you need.

Serious Causes of Calf Pain

Calf pain is often caused by muscle strain or cramps. But sometimes, calf pain can be a sign of something more serious, such as a ruptured Achilles tendon, peripheral artery disease, or a type of blood clot called deep vein thrombosis (DVT). If you experience symptoms of these conditions, make sure to see a healthcare provider.

Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a serious medical condition in which a blood clot forms in a deep vein of the leg. DVT is recognized by:

• Swelling
• Redness
• Warmth
• Tender, cramping pain at the site of the obstruction

DVT often occurs when someone is seated in a stationary position for a long period of time, such as during a long-haul air flight. People with cardiovascular disease, obesity, and other conditions are predisposed to developing these clots. And, although not common, people who are pregnant or postpartum are more likely to develop a DVT than those of the same age who are not.

Achilles Tendonitis or Rupture

The Achilles tendon is the largest tendon in the body. It is located on the back side of your leg and connects your calf muscle to your heel bone.

When the tendon becomes irritated, usually due to overuse, you may experience the following symptoms of Achilles tendonitis:

• A burning pain in the back of your leg just above your heel
• Calf pain and stiffness

A torn tendon is referred to as an Achilles tendon rupture. When the tendon tears, you may experience:

• Severe, sudden pain in the back of your leg
• Hearing a "pop" when the injury happens
• Difficulty bearing any weight on your leg

Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is a type of cardiovascular disease usually caused by the buildup of fatty deposits in the arteries of the upper and lower extremities.

PAD in the arteries of the lower legs is characterized by the following:

• Cramping pain during activity (claudication): This is due to narrowed or blocked arteries in the mid-thigh or knee.
• Pain in the buttock, hip, thigh, calf, and/or foot when walking short distances
• Some people experience pain in the affected leg while lying in bed at night—a sign that the condition is getting worse
  

Osteomyelitis

Osteomyelitis is bone inflammation usually caused by a bacterial infection. This infection may start in the bone itself or spread to the bone after an injury, such as a fracture. While anyone can get osteomyelitis, it's more common in children 5 years old or younger.

With this condition, you may experience:

• Constant, dull calf pain
• A sensation of warmth in your leg
• Redness and swelling in the leg
• Fever, in some people

Acute Injuries

In many cases, calf pain is brought on by a sudden trauma or injury. You may feel it after experiencing a fall or blow to your leg. Injuries can affect the bones, muscles, tendons, and nerves. If the trauma was severe, make sure to seek medical care right away.

Bone Fracture

A bone break or fracture in one of your lower leg bones (tibia or fibula) may be caused by falling or by a traumatic blow to your leg. This injury can cause the following symptoms:

• Severe calf pain
• Severe swelling in your lower leg, making it difficult to walk or bear any weight on your leg

A complete bone break can cause your leg to look deformed. This can also happen if the broken bone does not heal properly. To prevent this from happening, you may need a cast or possibly surgery.

Gastrocnemius Muscle Strain

A medial gastrocnemius strain is an acute injury that happens when the largest muscle of the calf is abruptly overstretched. Small tears in the muscle fibers cause the pain.

Gastrocnemius strains often happen during sports or activities that involve sprinting or jumping, including tennis and soccer.

If you strain your gastrocnemius muscle, you may experience the following symptoms:

• Hear a "pop" but feel no pain at the moment of injury
• Sharp or tearing pain that sets in after taking a few steps
• Calf swelling and bruising

The pain may be too intense to walk, or you may start limping to avoid putting weight on the injured leg. If untreated, this may lead to a muscle tear.

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.

This type of injury often occurs after a person falls, bumps into something, or is struck on the calf.

Typically, a contusion leads to symptoms such as:

• Skin discoloration
• Tenderness or severe pain
• Swelling, which 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.

Occasionally, contusions can lead to a hematoma (a pool of blood under the skin) that may take longer to heal or require surgical drainage.

Plantaris Muscle Rupture

A plantaris muscle rupture (tear) can occur when a lot of weight is suddenly placed on the ankle while the knee is extended. This small, superficial muscle is situated behind the knee and runs between the gastrocnemius and soleus muscles.

You may feel a sudden, snapping or popping pain in the back of your leg when the injury occurs. Bruising, swelling, and pain may take a few minutes, hours, or even days to develop. Some people may also experience cramping.

Fortunately, this injury tends to heal on its own.

Peroneal Nerve Entrapment

Nerve entrapment happens when calf nerves become compressed by the surrounding tissues. This is often referred to as a pinched nerve and can happen due to overuse or sudden trauma.

The peroneal nerve is most prone to nerve entrapment. When this nerve is pinched, you may feel:

• Numbness
• Tingling
• Sharp pain in the leg or the top of the foot

In severe cases, peroneal nerve entrapment can lead to foot drop, in which you have difficulty lifting the front of your foot due to muscle weakness.

Popliteus Tendonitis or Tear

The popliteus tendon wraps around your knee joint, connecting your thighbone to your popliteus muscle just below the knee. Your popliteus tendon and popliteus muscle work together to rotate and stabilize your knee.

Popliteus tendonitis happens when the tendon is inflamed, usually due to overuse. It causes pain just above the calf and in the back and side of the knee. The pain worsens when walking or running downhill.

In rare cases, the popliteus tendon can also tear. This is an acute injury that is usually caused by trauma, such as a direct blow to the inside of the knee. The injury causes pain and bleeding in the knee joint.

Other Causes

Sometimes, calf pain is not a result of a specific trauma. Symptoms can develop over time due to overuse, underlying health conditions such as arthritis, or even be present at birth.

Calf Muscle Cramp

A calf muscle cramp is a sudden, involuntary contraction of one or more calf muscles. These are often referred to as "Charley horses."

Around 30–37% of all people experience calf cramps. The cramps can last between a few seconds and 10 minutes.

Calf cramps may come with the following symptoms:

• Feeling intensely tight and painful
• Causing a visible knot
• Twitching sensation

Afterward, your calf muscle may be sore for a few days.

Calf cramps may be due to:

• Muscle fatigue following high-intensity exercise
• Vitamin and mineral deficiencies, such as low levels of vitamins B12 and D3
• Low iron levels
• Electrolyte imbalances and/or dehydration
• Medications such as Klonopin (clonazepam), Celebrex (celecoxib), Ambien (zolpidem), and Naprosyn (naproxen)

Soleus Muscle Strain

The soleus muscle plays an important role in lifting the heel off the ground. It also stabilizes your posture as you walk or run, preventing you from falling forward.

If you have a soleus muscle strain, you may feel deep soreness or tightness when you do the following:

• Press on your Achilles tendon
• Walk on your tiptoes
• Pull your toes toward your shin

Soleus muscle strain is a common overuse injury in endurance running. However, many runners do not notice any particular incident that caused it.

Symptoms tend to develop over time, and they include:

• Calf muscle fatigue (at the beginning)
• Swelling
• Bruising
• Sharp pain

These symptoms may worsen until it is too difficult to run at all.

Baker's Cyst

A Baker's cyst is a collection of knee joint fluid that pools in the back of the knee. This is common in people who have arthritis.

If a Baker's cyst ruptures, the fluid may leak down into the calf region, causing:

• An aching pain in the calf
• Swelling

The condition tends to revolve on its own.

Sciatica

A sciatic nerve, the largest nerve in the body, is found in both the right and left legs. It sends nerve impulses back and forth between the leg and spine and controls leg motion.

Sciatic nerve pain (also called sciatica) is very common and runs from the lower back down to the legs, as far as the calf. As with many chronic pain conditions, some people find they have more calf muscle pain at night.

Symptoms of sciatica are typically felt only on one side of the body, usually starting in the lower back and possibly extending to the leg, calf, foot, and toes. They include:

• Pain
• Weakness
• Numbness
• Tingling
  

Popliteal Artery Entrapment

Popliteal artery entrapment happens when the gastrocnemius muscle places pressure on the popliteal artery at the back of the leg and knee. This can restrict blood flow in the leg.

The condition may be congenital (present at birth) or develop over time. It is commonly seen in young athletes as their popliteal artery becomes compressed while their body is still growing.

The symptoms of popliteal artery entrapment include:

• Cramping
• Tightness
• Calf pain

These occur particularly after a vigorous lower leg workout (such as cycling or running).

Who Is At Greater Risk For Calf Pain?

Calf pain is more common in athletes and people who exercise frequently, therefore putting more strain on the calf muscles. It can also be caused by certain medical conditions that require treatment of an underlying medical issue. Calf pain, though, can also be caused by simple cramping (or involuntary contracting) of the leg muscles.

Aside from muscle fatigue, there are several risk factors that contribute to more frequent cramping of the calf muscles. These include:

• Aging due to normal muscle loss
• Pregnancy (Muscle cramping in the second or third trimester differs from deep vein thrombosis, which may include pain or tenderness, but concern should be brought to the attention of a medical professional.)
• Dehydration and electrolyte imbalance (Electrolytes, like potassium, sodium, and chloride, help prevent muscle cramps.)
• Certain diseases, such as hypothyroidism, kidney failure, metabolic issues, and peripheral artery disease (PAD)
• Smoking (which is a major risk factor for PAD)
• Liver disease due to alcoholism
• Taking medications that lower high blood pressure or cholesterol

Diagnosis

To diagnose your calf pain, a healthcare provider will likely perform a physical exam and ask you about your medical history. Other tests may be performed based on the initial findings.

Medical History

Prior to your healthcare provider's visit, it's a good idea to jot down a couple of notes about your calf pain that could help your healthcare provider pinpoint the cause. For example:

• When it started
• What it feels like
• Whether it is present at rest and/or with activity (and what type)
• Whether it is worse at night
• Whether you have any other symptoms like numbness or swelling

In addition to asking about the specifics of your calf pain, your healthcare provider 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 healthcare provider 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 them. They will likely perform other special tests if they suspect a certain diagnosis.

The Thompson test is one example. During this test, you'll be asked to lie flat on an examination table with your foot hanging over the edge. Your healthcare provider then squeezes your calf muscle. If your toes do not flex downward, an Achilles tendon rupture would be suspected.

Blood Tests

Certain blood tests may help identify the cause of calf pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests can detect general inflammation common with infections.

A D-dimer test may be ordered to help diagnose DVT or pulmonary embolism. 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 somewhere in your body.

Imaging

X-rays can reveal many types of abnormalities in the lower leg, ankle, or knee (particularly problems with bones and joints).

An ultrasound (sonogram) or magnetic resonance imaging (MRI) may be used to evaluate calf tendon injuries and tears.

If your healthcare provider 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.

Treatment

Rest, elevation, and ice application are among the fastest ways to relieve calf pain. And in many cases, they are sufficient.

If home treatment doesn't work, or your pain is significant, ongoing, or paired with other symptoms, you may need something more. Your healthcare provider may suggest medication, physical therapy, or other treatments, depending on your diagnosis.

Surgery is rarely needed to treat calf pain, but it may be necessary for more severe injuries, such as a torn Achilles tendon or a blocked popliteal artery that won't heal on its own.

RICE Method

The first treatment, in most cases, is to rest the muscles and allow the acute inflammation to lessen. A common approach is called the RICE method, which stands for:

• Rest
• Ice application (applying ice to ease pain and inflammation)
• Compression (using a compression bandage on the affected area)
• Elevation of the affected limb

Don’t apply heat or massage the area initially. Also, don’t walk or strain the muscle. If the pain or loss of mobility is severe, have the injury checked by a healthcare provider.

Stretching and Physical Therapy

Stretching the muscles and tendons of the calf can help with some causes of calf pain. It's important to stretch regularly and use proper stretching techniques to prevent further injuries.

Consult with a physical therapist to learn a stretching routine that suits your injury.

Physical therapy is an important part of treatment for almost all orthopedic conditions. Physical therapists use different techniques to help you increase strength, regain mobility, and return to your pre-injury level of activity.

Medications

Nonsteroidal anti-inflammatory medications (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) are some of the most commonly prescribed medications, especially for people with tendinitis or a muscle strain, contusion, or cramp.

Less commonly, a cortisone steroid injection may be used to treat certain causes of calf pain.

If you are diagnosed with a blood clot, you will likely be placed on a blood thinner (anticoagulant), such as warfarin or Xarelto (rivaroxaban). These medications prevent your current blood clot from getting bigger and new clots from forming.

Prevention

There are some lifestyle habits you can adopt to prevent many causes of calf pain, especially muscle-related ones. These are just a few examples.

To prevent muscle cramps and strains in your calf:

• Warm up before strenuous activities: This may include stretching, jumping jacks, or gently jogging in place. The point is to ease your muscles into activity rather than starting suddenly.
• Cool down after your workout: This means slowing down your activity for at least five minutes before stopping completely.
• Avoid over-exercising, especially in very hot temperatures.
• Stay hydrated: Drinking an electrolyte drink can help stave off muscle cramps caused by electrolyte imbalances. You should also limit alcohol and caffeine as both can dehydrate you.

The risk of peripheral artery disease, DVT, and other vascular disorders can be reduced by:

• Stopping smoking
• Maintaining a healthy weight
• Exercising routinely
• Eating a low-fat diet rich in vegetables, fruits, whole grains, and fiber
• Avoiding processed foods, saturated fats, and sugary foods
  

Summary

Many causes of calf pain, such as cramps, are common and not serious. Some causes are brought on by a sudden trauma or injury and require immediate medical care. Yet others, such as deep vein thrombosis (DVT) or peripheral artery disease (PAD), aren't brought on by noticeable traumas but require a medical evaluation right away.

If your pain is severe, persistent, or worsening, or if your symptoms worry you, don't hesitate to consult a healthcare provider. Other symptoms of concern include an inability to walk comfortably, leg deformity, pain at night or while resting, swelling, or signs of an infection such as fever, redness, and warmth.