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, seek immediate medical care (call 911).
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
- Reduced range of motion
- Skin discoloration, such as bruising
- Sleep disturbances
- 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
What causes calf pain?
Most calf pain is due to overuse, injury, and age-related wear and tear on the muscles, tendons and ligaments of the calf. There are two calf muscles—gastrocnemius and the soleus—that meet at the Achilles tendon, which is attached to the heel bone. Overstretching (either from overuse or injury) or tearing one of these muscles is a calf strain or tear, respectively. Usually, calf muscle injuries are not serious. You can prevent and treat overuse and minor injuries with self-care and lifestyle changes. For example, proper rest between periods of exertion and conditioning before extreme sports are two practical methods of avoiding trauma and pulled muscles.
However, infectious diseases, blood circulation problems, and other abnormal processes can also affect the calf. In some cases, calf pain may be a symptom of a serious or life-threatening condition. In particular, upper calf pain or pain behind the knee is one sign of a deep vein thrombosis, which is a blood clot deep in the leg that can lead to a pulmonary embolism, heart attack, or stroke. Calf pain can also be a sign of peripheral artery disease, which leads to intermittent pain in the legs, particularly upon mild exertion or walking.
Injury-related causes of calf pain
Calf pain may arise from injuries including:
- Laceration or contusion
- Muscle cramp (charley horse) commonly caused by dehydration or overuse
- Pulled or torn muscle (muscle strain) or tendon; you may feel or hear a snap or pop if the muscle or tendon tear is severe
- Pulled or torn ligament (sprain), such as the Achilles tendon
Infection-related causes of calf pain
Calf pain may arise from various infections including:
- Cellulitis (skin infection)
- Infected wound or other sore
Degenerative, inflammatory, and neurological causes of calf pain
Calf pain can be caused by degenerative, inflammatory, and neurological conditions including:
- Nerve entrapment or compression
- Peripheral neuropathy, such as diabetic neuropathy
- Tendinitis (inflammation of a tendon)
Other causes of calf pain
Calf pain can be due to serious, life-threatening conditions including:
- Deep vein thrombosis (blood clot in the leg that can break loose from the leg, causing a pulmonary embolism in the lung, a heart attack, or stroke)
- Peripheral artery disease (PAD, also called peripheral vascular disease, or PVD; a narrowing of arteries due to a buildup of fat and cholesterol on the walls of arteries, which limits blood flow to the extremities). Intermittent claudication is the medical term for calf or leg pain, numbness, or cramping due to PAD.
Questions for diagnosing the cause of calf pain
To diagnose the underlying cause of calf pain, your doctor or licensed healthcare practitioner will ask you several questions related to your symptoms. You can best help your healthcare practitioner in diagnosing the underlying cause of calf pain by providing complete answers to these questions:
- What is the exact location of your pain?
- Describe the pain. When did it start? Did it develop slowly or suddenly? Is it constant or intermittent?
- Is there any swelling?
- Are you experiencing any other symptoms?
Provide your full medical history, including all medical conditions, surgeries and treatments, family history, and a complete list of the medications and dietary supplements that you take.
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.
Perform gentle calf stretches for muscles cramps and for minor calf injuries after 1 to 2 days of RICE (rest, ice, compression, elevation):
- 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.
Calf stretches also help prevent calf strains and cramps.
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.
- 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.
When should you see a doctor for calf pain?
Although most causes of calf pain are not serious, there are times when seeing a healthcare provider is the safest option to determine the extent of the injury or diagnose more serious causes.
See a doctor promptly when:
- Your pain occurs after walking or mild exertion and does not go away.
- Your leg is cool and pale, particularly one leg compared to the other.
- Your lower leg swells, feels warm, and becomes tender to touch.
- You see red streaks around a tender area or lump in the calf.
- You are losing sensation in the calf or in other parts of the leg.
- You experience calf pain after prolonged sitting.
- You feel a popping or tearing sensation at the time of the injury.
- Your calf pain worsens despite 1 to 2 days of self-care.
Call 911 or go to your nearest emergency room for calf pain when:
- You cannot stand or walk on the affected leg.
- You experience redness, swelling and warmth in the calf. You may also have a fever.
- You experience shortness of breath with leg or calf pain or with swelling in both legs.
What are the potential complications of calf pain?
Complications associated with calf pain can be progressive and vary depending on the underlying cause. Mild calf pain due to overuse usually responds to rest, ice, and over-the-counter anti-inflammatory medications. Because calf pain can be due to a serious disease, failure to seek treatment can result in complications and permanent damage. It is important to visit your healthcare provider when you experience any kind of persistent pain or other unusual symptoms. Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can lower your risk of potential complications including:
- Inability to perform daily living tasks
- Loss of limb (amputation)
- Loss of strength
- Permanent nerve damage
- Pulmonary embolism (blood clot in the lung)
- Spread of infection