What is calf pain?

Calf muscle pain can be a dull ache or a sharp pain in the back of your leg below the knee. It can present differently in different people depending on the cause. It is often caused by muscle strain or cramps.

Muscular calf pain and cramps often occur when you’ve been doing some physical activity like walking or running. Calf pain of sudden onset can indicate a problem with your blood vessels.

Pain in your legs and feet at night when lying down is often due to peripheral artery disease (PAD).

Calf pain or calf strain recovery depends on the cause. Muscle pain usually heals within a short time but some cases may need treatment and may need a longer time to recover.

What causes calf pain?

Cramp

Having a cramp in the calf is quite common and is due to the calf muscle going into a spasm (muscle suddenly contracts). This can happen if you have been doing some new exercises and have overworked the calf muscles. This is more likely if you are dehydrated or lacking in electrolytes. Cramps normally go away quite quickly by themselves.

Calf strain

The calf is made up of two muscles called the gastrocnemius and the soleus, which converge and meet at the Achilles tendon. This tendon is attached to the calcaneus bone (bone of the heel).

Overstretching or a tear in one of these calf muscles causes calf strain. This causes sudden pain in the back of your leg and may be accompanied by stiffness and weakness when you walk.

Achilles tendonitis.

In this condition, the Achilles tendon becomes inflamed. The Achilles tendon attaches the calf muscle to your heel bone.

The tendon can become inflamed due to overuse and cause a burning pain in the back of your leg along with calf pain and stiffness.

The tendon can also tear due to sudden extra force being exerted on it. This will cause sudden severe pain in the calf. There will be difficulty putting your body weight on that leg.

Sciatica

The sciatic nerve is the largest nerve in the body. It originates in the spinal cord and runs down both legs. Sciatica is the pain of the sciatic nerve that runs from the lower back down to the calf. This causes more pain during the night.

It is usually caused by a herniated disk in the spine or bone spurs that form on the spinal bones. This compresses the sciatica nerve and hence the radiating pain down the leg to the calf.

Contusions

A direct blow to a muscle can damage your muscle tissue and cause a contusion. This is accompanied by bruising and soreness. The skin over the calf remains intact but blood vessels under the skin are ruptured.

Contusion typically leads to skin discoloration along with tenderness and severe pain, which can limit your ability to walk.

Diabetic peripheral neuropathy

Diabetic neuropathy is the damage caused by uncontrolled diabetes. High blood sugar levels can injure nerves throughout the body.

It most often develops in the nerves of the legs and feet. Due to the nerve damage, there are symptoms of pain and numbness in the legs and feet.

Deep vein thrombosis (DVT)

DVT is a medical emergency that develops when a blood clot forms in the deep veins of the arm or leg. DVT in the leg presents with swelling, redness, and warmth in the calf. There is tenderness and cramping pain.

Besides other causes, DVT often occurs due to prolonged immobilization like sitting for extended periods such as on long trips in a car, bus, train, or airplane

Claudication

Claudication refers to an aching, cramping, and burning pain in the calf of one or both legs. It typically occurs with physical activity such as walking for a particular distance and for a particular amount of time and subsides with rest.

Claudication occurs due to narrowed arteries that prevent your calf muscles from receiving enough blood and subsequently depriving them of oxygen.

When the pain also happens at night while lying in bed at night, it indicates that the condition is getting worse

Intermittent claudication pain is especially common in people who smoke or who have diabetes or peripheral artery disease.

Risk factors

Though anyone can get calf pain, the following factors increase your risk of developing calf pain.

  • It is more common in athletes and people who perform intense exercises that put excess strain on their calf muscles.
  • People over age 65 are also at a higher risk of lower calf pain due to muscle weakness caused by advancing age.
  • Certain medications, including cholesterol-lowering drugs such as statins. Statin-related muscle pain affects both sides of your body equally.
  • Diseases such as hypothyroidism, liver disease, and kidney disease,
  • Heat exhaustion
  • Dialysis used in patients with kidney failure
  • Pregnancy

When should I see my doctor?

See your doctor if:

  • your calf is swollen
  • your calf is painful during or after walking
  • your leg feels numb
  • your leg feels weak
  • you have fluid retention
  • your calf is discolored, warm, and tender
  • swelling is present in both legs
  • the pain gets worse and does not improve with RICE treatment
  • you have painful varicose veins

Particularly look for symptoms of DVT and seek prompt medical attention if they are present. These include if:

  • Pain in leg
  • Swollen calf
  • the skin over the calf is red
  • your calf feels warm to touch

Diagnosis

To diagnose the cause of your calf pain, a healthcare provider will take your medical history and ask for your symptoms after which he will perform a physical exam. He will further order some tests based on the initial findings.

Medical history

The medical history will involve asking about your symptoms, any trauma, or any pre-existing disease. About the pain, your doctor might want to know the following:

  • When did the pain start?
  • Did it come on suddenly?
  • What type of pain?
  • Site of pain?
  • Does it occur after some activity?
  • Does it happen at night?

Clinical examination

The clinical examination will involve looking for signs of swelling, tenderness, warmth, and discoloration or redness. He will look for the following findings:

  • Calf or ankle edema may indicate DVT or valve insufficiency
  • Reddening of the skin may indicate Erysipelas (skin infection)
  • Intermittent claudication will indicate lower limb ischemia
  • Back pain radiating to the leg will indicate sciatica
  • Pain near the heel may indicate Achilles tendon injury
  • The pain of sudden onset may indicate calf muscle injury or arterial embolism
  • Pain that develops in an athlete may indicate a stress fracture

Blood tests

Certain blood tests may help identify the cause of calf pain.

  • ESR and C-reactive protein blood tests will help to detect any inflammation that is common with infection.
  • A D-dimer test may help diagnose DVT or pulmonary embolism. A positive test means the D-dimer level in your body is higher than normal and means there may be a blood clot somewhere in your body.

Imaging tests

  • X-rays of the lower leg can reveal problems with bones and joints.
  • An ultrasound (sonogram) or magnetic resonance imaging (MRI) may be used to rule out calf tendon injuries and tears.
  • A vascular study will help to rule out a blood clot that may form in the deep veins of the leg.

How is calf pain treated?

When you have calf pain, do not apply heat or massage the area. Don’t walk or strain the muscles. If you have a muscle cramp, gently massage the muscle. If you have a calf strain or Achilles tendonitis, use the home method of treatment: ”RICE”.

RICE method

  • Rest the area. Do not walk or run when you have calf pain.
  • Ice the area with a covered icepack for 20 minutes every two hours. Don’t apply ice directly to your skin.
  • Compress the area with a bandage. Compression helps reduce blood flow and minimize swelling. However, if the pain gets worse, loosen the bandage.
  • Elevate the lower leg while sitting or lying down by putting it on a platform about six inches above the bed level. Support the entire length of your leg with pillows, blankets, or cushions.

Medications

For cases of tendinitis, muscle strain, contusion, or cramp, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are commonly prescribed. After 48 hours of starting the drugs, gently start stretching the calf muscle.

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

Surgery may be necessary for more severe injuries, such as a torn Achilles tendon.

Return to full physical activity only after the pain and tenderness have gone and the strength has fully returned to your calf.

Prevention

  • Adopt some lifestyle habits to prevent muscle-related calf pain.
  • To prevent muscle cramps and strains in your calf:
  • Warm up before strenuous exercises.
  • Similarly, cool down after your workout by slowing down your activity for five minutes before stopping completely.
  • Do not over-exercise.
  • Stay well hydrated.
  • Limit alcohol and caffeine as they can dehydrate you.
  • If you are diabetic, keep your blood sugar levels under control.

To prevent or reduce the risk of peripheral artery disease and DVT: