When Should You Worry About Calf Pain? (and What to Do Next) (2024)

Calf muscle pain is common and can be severe, even if the underlying cause is benign (harmless) and reversible, like an exercise-associated muscle cramp or strain. In some cases, though, calf pain is a sign of a serious health problem, like nerve damage, narrowing of blood vessels, or a blood clot deep within a lower leg vein—called deep venous thrombosis.

If you are experiencing calf pain, it's important to know when to seek medical attention and, if the cause is mild and muscular, what remedies you can implement at home to ease the pain.

When to Go to the ER

Calf pain is not usually a cause for concern. However, the following symptoms or scenarios indicate that something potentially dangerous may be happening.

Go to your nearest emergency room if you are experiencing calf pain along with the following symptoms/scenarios:

• Swelling, redness or discoloration, and/or warmth in the calf (or anywhere within the leg)
• Severe dehydration (e.g., no urination, inability to drink/keep fluids down, confusion, persistent vomiting or diarrhea)
  
• Difficulty or inability to walk or move your leg, or having had significant leg trauma (e.g., from a car accident or sports injury)
• Open, nonhealing sores on wounds or skin discoloration (e.g., bluish or unusually pale color) on the leg, feet, or toes
  
• Severe, sudden pain like being struck violently in the back of the leg, sometimes accompanied by hearing a "pop."
• Lower back or leg pain accompanied by sudden weakness, loss of sensation, or bladder/bowel retention or incontinence

When to Contact a Healthcare Provider

While not necessarily an emergency, contact a healthcare provider if your calf pain persists despite conservative/home remedies (discussed below). You might have a nerve, hormonal, or joint condition requiring additional care.

Also, see a healthcare provider if you have calf pain and:

• A fever, night sweats, or unintentional weight loss
• A weakened or suppressed immune system
• Are taking a medication that thins your blood or any medication that may be causing muscle cramps as a side effect
• A history of or current cancer
• Are 60 years of age or older

Potential Causes and Treatment of Acute Calf Pain

Multiple possible causes of acute (sudden) calf pain exist, including irritation or damage to the calf muscle or the tendons, nerves, and blood vessels connecting to or feeding it.

Cramps

Calf muscle cramps are sudden, brief contractions (tightening and squeezing) of the calf muscles that cause pain. The pain may be accompanied by stiffness and visible knotting of the calf muscle, followed by stiffness that can last for days.

Calf muscle cramps can occur for several reasons. Common causes include:

• Benign cramps that occur at night
• Exercise-related cramps due to muscle fatigue or electrolyte imbalances (e.g., low potassium or magnesium in the blood)
• Taking medications like diuretics (increase urine and remove excess water and salt from the body)

In some cases, though, calf muscle cramps are a sign of a serious health condition related to the nerves and blood vessels in the lower body.

Treatment of calf muscle cramps entails identifying and fixing the underlying problem.

For example, if you wake up in the middle of the night with a calf cramp or develop one after going for a long run, these strategies are usually sufficient to ease the cramps:

• Stretching the calf muscle (pulling your toes and foot upwards)
• Drinking a tall glass of water, possibly supplemented with electrolytes for exercise-associated cramps

Strain

A calf strain is a tear injury to one of the muscles or tendons (which connect muscle to bone) in the back of the lower leg. Like calf muscle cramps, it's one of the most common causes of calf pain, although it usually occurs in athletes who run up hills, jump, or play football, soccer, tennis, or basketball.

The calf has two muscles—the gastrocnemius and the soleus—and tears to the fibers of these muscles can be mild or severe and cause sudden or gradual, intermittent pain. Severe strains refer to a complete muscle tear, resulting in a loss of function.

The pain of a calf strain feels tight, cramping, gripping, sharp, or sore. Muscle weakness or swelling may accompany the pain.

Treatment for a calf strain typically involves the RICE protocol, which stands for:

• Rest until you can walk without a limp. A walking boot or crutches may be needed.
• Icethe calf four times daily in 10- to 20-minute intervals until muscle swelling improves.
  
• Compress the calf using a compression sleeve to reduce swelling.
• Elevate the affected leg above heart level to reduce swelling.

Besides the RICE protocol, short-term use of an over-the-counter pain medication like Tylenol (acetaminophen). Or, a nonsteroidal anti-inflammatory drug (NSAID), such as Advil and Motrin (ibuprofen) or Aleve (naproxen),may be recommended.

Physical therapy or home-based exercises are implemented to ease pain and restore movement. Surgery is rarely performed and is reserved for severe tears.

Achilles Tendonitis

The Achilles tendon is a large, strong tissue band connecting the calf muscles to the heel bone. Achilles tendonitis is irritation or inflammation of the Achilles tendon, usually caused by overuse or repeated stresses from, for example, excessive running or jumping.

Achilles tendonitis symptoms include soreness and stiffness along the tendon and back of the leg, especially after activity and in the morning after getting out of bed.

Other symptoms include:

• Thickening or swelling of the tendon
• Pain that becomes severe the day after exercising
• Pain on the back of the heel that is felt when wearing shoes

Treatment involves several elements:

• Resting the affected foot and leg and avoiding/modifying sports and activities that cause pain
• Icing the lower leg for the first two days after the injury or pain begins, every six hours daily for 15-minute intervals
  
• Taking anti-inflammatory medicine such as an NSAID
• Wearing different shoes or using heel lifts (inserts in the shoe to help relieve pain)
• Seeing a physical therapist for strengthening exercises and massage

Varicose Veins

Varicose veins are bulging, twisted superficial veins that primarily manifest on the legs, including the calf region. They are generally harmless and present in 10% to 40% of adults between 30 and 70.

If varicose veins cause symptoms, they're usually mild. They cause a heavy, burning, tired, or aching sensation that worsens after standing or sitting for long periods. Itching and skin discoloration may also be present.

Treatment of varicose veins aims to soothe symptoms and prevent the condition from worsening.

Therapies often include a combination of the following:

• Avoiding sitting or standing for long periods
• Maintaining a healthy weight
• Propping your legs up for 30-minute intervals during the day
• Wearing compression stockings

In some cases, sclerotherapy (a procedure that involves injecting a solution into the vein to seal it off) may be performed to improve symptoms or the cosmetic appearance of the leg.

Baker’s Cyst

ABaker's cyst is a fluid-filled sac that forms in the back of the knee. It most commonly develops in adults between the ages of 35 and 70 and individuals with a history of arthritis or a knee joint injury (e.g., meniscus tear).

Most people with a Baker's cyst have no symptoms, although some experience a bulging sensation behind the knee associated with vague pain or stiffness.

A Baker's cyst sometimes breaks open, and the knee joint fluid leaks through tissue into the calf area. Symptoms like calf swelling, redness, tenderness, and bruising may develop in such cases.

If a Baker's cyst causes no symptoms, treatment is not usually necessary as the cyst resolves on its own. If symptoms are present, treatment options include:

• Taking NSAIDs
• Injecting a steroid (a strong anti-inflammatory drug) into the knee joint
• Draining the cyst followed by a steroid injection
• Removing the cyst surgically

Sciatica

Sciatica describes pain in the sciatic nerve, a wide and large nerve that runs from the right and left sides of the lower back down the buttocks and leg, ending just below each knee. The sciatic nerve then divides into several branches that continue into the foot.

Sciatica can manifest when the sciatic nerve is pinched, inflamed, or damaged by, for example, a herniated ("slipped") disc or bone spur (bony outgrowth) from osteoarthritis (chronic joint disease causing a breakdown of cartilage).

Symptoms of sciatica range from a mild burning or aching pain to a severe shooting pain that can travel from the low back down the back of the leg, over the calf, and toward the heel. Weakness and numbness in the leg or foot may also be present.

Treatment often includes a combination of strategies, such as:

• A physical therapy program that involves core muscle strengthening and stretching exercises
• Pain medication like an OTC NSAID or a nerve-pain drug like Neurontin (gabapentin)
• Lifestyle behaviors like avoiding smoking and maintaining a normal weight

If the pain persists or is severe despite the above measures, a pain specialist can inject cortisone (a steroid) into the epidural space. This is the area between the spine and the outer tissue surrounding the spinal cord.

Surgery to treat the underlying cause (e.g., a herniated disc) is considered a last resort option

Lower Leg Fracture

A calf bone (fibula) fracture is a bone break, often caused by a minor trauma associated with a twisting injury or direct blow to the side of the leg. Common causes of fibular fractures are falls or injuries related to snowboarding, skiing, or contact sports like football and soccer.

The intensity of pain associated with a calf bone fracture depends on the extent and type of injury. With fractures from minor falls or injuries, people can typically walk, although the pain worsens when doing so.

Swelling along the lower leg, bruises, cuts, and, in severe cases, jutting out of the bone through the skin may also be present.

For isolated, nondisplaced (the bone does not move far out of place) fibular fractures, treatment includes:

• Immobilization with a splint or cast, depending on the pain level and fracture severity
• Icing of the lower leg
• Elevation of the lower leg
• Taking a pain medication
• Physical therapy with a full recovery expected to be six to eight weeks

Keep in mind that for more significant traumas, like a severe crush injury, both the fibula and the shin bone (tibia) may break.

Such cases require immediate referral to an orthopedic surgeon (a surgeon specializing in treating diseases of bone and surrounding tissues).

Claudication

Claudication refers to muscle pain felt deep within the calves, thighs, or buttocks during movement due to insufficient blood flow. The pain is typically reported as crampy and relieved with rest.

Claudication is most often caused by peripheral artery disease, a condition marked by the narrowing of the blood vessels that carry oxygenated blood to the legs. This narrowing is due to the accumulation of fatty deposits (plaque) within the walls of the arteries.

The most common location of pain from claudication is the calf. Pain severity varies widely, depending on several factors, such as the number of arteries affected, the degree of narrowing, and the activity being performed (e.g., pain is more intense when climbing stairs).

Treatment involves several elements, including:

• Lifestyle behaviors like stopping smoking and getting underlying conditions like diabetes, high blood pressure (hypertension), and high cholesterol (if present) under control
• Participating in a supervised walking program
• Taking a prescription drug called Pletal (cilostazol) to improve blood flow to the legs and ease pain while walking

If pain is severe despite the above measures, a procedure like angioplasty to widen the narrowed affected artery or bypass surgery to reroute blood flow in the leg may be performed.

Neurogenic Claudication

Neurogenic claudication—also known as pseudoclaudication—is a hallmark feature of lumbar spinal stenosis, a lower back condition in which the space between the bones in the lumbar spine narrows.

Unlike claudication (discussed above), neurogenic claudication is not a blood vessel problem but a nerve problem resulting from compression of spinal nerves in the lower back.

Symptoms include tingling, aching, or cramping pain in one or both buttocks, thighs, or calves. Balance problems, numbness, and weakness may also be present. The pain worsens with walking and standing upright and is alleviated when leaning forward or sitting down.

Treatment often involves a combination of therapies like taking painkillers, physical therapy, epidural steroid injections, and sometimes complementary therapies like acupuncture.

For severe or persistent symptoms, an operation called a laminectomy may be performed to relieve the nerve compression in the lower back.

Bone Infection

A bone infection—known medically as osteomyelitis—occurs when germs like bacteria spread to the bone from the bloodstream or nearby infected tissues. A significant injury that exposes the leg (or any) bone can also cause it to become infected.

Symptoms of osteomyelitis include a dull, constant pain at the affected site, sometimes along with swelling and fever.

Treatment usually begins with surgery to remove the tissue and bone that died from the infection. After surgery, antibiotics are given for several weeks, if not months (or antifungals, if the germ is a fungus).

Deep Vein Thrombosis (DVT)

A deep vein thrombosis is a blood clot found in a deep vein, usually within the leg. Some DVTs cause no symptoms, but if they are present, a DVT in the calf may cause swelling, pain, warmth, and redness or discoloration.

The standard treatment for a DVT is taking an anticoagulant (blood thinner). Anticoagulants help prevent new blood clots from developing and DVT complications like pulmonary embolism and postthrombotic syndrome—a type of chronic venous insufficiency that causes pain and swelling near the affected vein.

Depending on the scenario, other treatment options for a DVT include:

• Taking a thrombolytic (a clot-busting drug)
• Having an inferior vena cava (IVC) filter (a small device intended to block blood clots from traveling to the lungs) placed

Chronic Compartment Syndrome

Chronic compartment syndrome generally manifests as a result of athletic exertion, often running. Pressure accumulates to such high levels within the muscles being used that vital blood flow to nerve and muscle cells is temporarily interrupted.

The cramping pain of chronic compartment syndrome is typically felt deep within both calves or shins. It slowly increases in intensity after physical activity begins and then resolves within 15 minutes of stopping.

Numbness of the foot and ankle and muscle bulging or swelling may accompany the pain.

Chronic compartment syndrome is not dangerous since symptoms resolve when the activity is stopped. However, to continue the activity, various measures may be implemented to try to prevent the syndrome from developing in the first place.

Examples of such measures may include;

• Seeing a physical therapist for massage, stretching, and possible modification of the mechanics involved in the activity
• Switching surfaces where activity is performed (e.g., running on a track vs. a sidewalk)
• Wearing arch supports or orthotics (pads or inserts for shoes)

If nonsurgical measures fail, an operation called a fasciotomy may be considered. With a fasciotomy, the tissue surrounding the affected muscle is opened, allowing room for the muscle to swell during exertion.

Diabetic Peripheral Neuropathy

The term "neuropathy" means "nerve damage" and is a common complication of diabetes, a condition characterized by high blood sugar levels. Chronically high blood sugar levels damage small vessels that feed peripheral nerves (the nerves outside your spinal cord), impairing nerve signaling.

Symptoms of diabetic peripheral neuropathy tend to be worse at night and include:

• Burning pain
• Numbness that starts in the toes and feet on both sides
• Tingling

The severity varies widely, but as the condition progresses, the pain and abnormal sensations move up the left to the mid-calves and hands.

Treatment of diabetic peripheral neuropathy involves several elements, including:

• Adopting healthy lifestyle habits like maintaining a normal weight and exercising
• Controlling blood sugar levels
• Taking a nerve pain medicine like Cymbalta (duloxetine) or Lyrica (pregabalin)

Summary

The calf muscles are located in the back of the lower leg, behind the shinbone, and below the knee. Calf pain is a very common complaint and may be caused by a wide range of health conditions.

Some causes of calf pain, like nighttime leg cramps, a mild calf muscle tear, or Achilles tendon inflammation, are generally harmless and reversible with conservative/home remedies.

Other causes of calf pain, though, are more serious. They may indicate nerve damage or blood vessel narrowing within the leg. A blood clot within a deep vein of the calf (DVT) is especially alarming, as it can travel to the lungs and be fatal.

Seek medical attention if the cause of your calf pain is unknown, severe, persistent, or associated with worrisome symptoms mentioned above—for example, redness or warmth, trouble or inability to walk, or skin discoloration.