What To Know and Do About Calf Pain

Your calf consists of nine muscles. The two largest muscles—the gastrocnemius and the soleus— are both located in the back of your lower leg below your knee. Calf pain may feel like a dull ache or sharp pain in both or either of these muscles or from a non-muscle organ in the lower leg. The pain may come and go or persist throughout the day.

Calf pain can come from muscle strain in your calf, anatomical (body structure) problems, and many other causes. See a healthcare provider for pain that stays persistent even after resting your legs or if you have other symptoms like fever, swelling, or bruising in your calf.  

Potential Causes of Calf Pain

There are many causes of calf pain, ranging from minor issues that resolve with time, self-care, and rest to more serious problems that require immediate medical attention and treatment. 

Muscle Cramp

A spasm is the sudden, involuntary contraction of your calf muscles. Also known as a charley horse, you may experience this pain during or after exercise that feels like tightness in your calf muscle(s). The pain may last several seconds and up to a few minutes.  

Dehydration and deficiency in minerals like sodium and potassium can also cause muscle cramps. People with alcohol use disorder, hypothyroidism (having an underactive thyroid), or kidney conditions are more likely to experience calf pain. Being pregnant or menstruating can also increase your risk.

Muscle Strain 

A calf muscle strain is an injury that develops when muscle fibers overstretch and tear. Most strains occur in the gastrocnemius and soleus calf muscles, which support strenuous physical activity.

Calf muscle strains can occur suddenly or develop gradually over time from overuse or improper body positioning. Pain from a muscle strain is usually sharp or throbbing and worsens during movement. Sometimes strained muscles bleed, resulting in bruising around your calf that can extend to your ankle or foot. 

Achilles Tendinitis 

Achilles tendonitis is a condition characterized by inflammation and irritation of the Achilles tendon, the thick band of connective tissue that connects your calf muscles to your heel bone. Your Achilles tendon helps you move your legs and feet. Overuse and repetitive stress on the Achilles tendon can cause the tendon fibers to break down and tear.

Tears can lead to a dull ache or tenderness along the calf or back of the heel that worsens with physical activity. Your risk of developing Achilles tendonitis is higher if you are an athlete, spend a lot of time on your feet at work, or suddenly increase how much you exercise.

Along with pain, you may experience morning stiffness and swelling in your calf. It may be uncomfortable wearing shoes that rub against the back of your heel. 

Deep Vein Thrombosis 

Deep vein thrombosis (DVT) is when a blood clot forms in one of the deep veins in your body. DVT most commonly occurs in the leg, reducing blood flow in your leg and back to your heart. However, it can also occur elsewhere, such as your lung (pulmonary embolism) or heart (cerebral embolism). Having DVT is a medical emergency that requires immediate medical attention.

Calf pain that develops from a blood clot feels similar to muscle cramping or a pulled muscle. You may feel a similar worsening pain when standing or walking. Other symptoms may include swelling and redness in the affected leg, which may feel warm to the touch.

Risk factors for developing DVT include:

• Prolonged sitting
• Recent surgery
• Having obesity
• Having heart disease
• Having a lung disease

Sciatica 

Sciatica is a condition that occurs due to an injury to your sciatic nerve. Your sciatic nerve provides sensations in your legs and controls muscles in your calf. Sciatica can cause pain, weakness, numbness, or tingling in the affected leg. You may have sharp pain that starts on one side of your lower back and radiates down your leg.

The pain caused by sciatica may worsen at certain times of the day or during specific movements requiring movement in your leg. Sciatica is most common in people between the ages of 30-50. It is more likely to develop in people with arthritis or a history of herniated discs.

Peripheral Artery Disease 

Peripheral artery disease (PAD) develops when the arteries supplying blood to the legs narrow and decrease blood flow to your extremities. Impaired blood flow can damage muscles, nerves, and other tissues in the arms and legs. When you have PAD, calf pain may feel like cramping or muscle tightness.

Over time, symptoms may occur with less intense exercise, and your legs may feel numb or cool when resting. PAD can also cause intense calf muscle cramps at night. Some people experience such intense pain that pressure from clothing or bedsheets can become unbearable.  

Risk factors for PAD include smoking cigarettes and having atherosclerosis (build-up of plaque in the arteries of your heart) or hypertension (high blood pressure). PAD is more common in people assigned male at birth and people who are age 50 and older. People with certain health conditions, such as diabetes, heart disease, and kidney disease, are also at greater risk for PAD.  

Less Common Causes 

Less common causes of calf pain include: 

• Bone fracture: A fracture (break) in one of the bones in your lower leg. Fractures tend to happen in the fibula or tibia bones in your lower leg, making walking on the affected leg painful. A broken bone can also cause swelling, bruising, and tenderness when touched. You may also feel numbness.
• Popliteal cyst (Baker's cyst): This is a fluid-filled sac behind the knee. It can cause swelling, pain, or tightness that begins at the back of your knee and extends down your leg. Popliteal cysts develop when inflammation inside the knee joint causes fluid buildup behind your knee.
• Compartment syndrome: The buildup of pressure within muscles can decrease blood flow and prevent oxygen from reaching muscles and nerves in your legs, causing painful tingling or burning sensations. Chronic (long-term) compartment syndrome is most common in athletes. 
• Osteomyelitis: A bacterial infection affecting a bone in your leg may cause calf pain, chills, and warmth around the affected area.

When To See a Healthcare Provider

While some calf pain resolves with home remedies, experiencing certain symptoms may mean you need medical attention. Common symptoms that may require medical attention include redness, fever, and bruising.

See a healthcare provider if you also notice that the skin around your calf feels cold and in pain. You should get immediate medical attention if your pain starts to feel severe, you have difficulty standing, or lose sensation in your leg.

How Is Calf Pain Diagnosed?

To determine what's causing calf pain, your primary care provider or an orthopedist (a physician specializing in bone and muscles) will review your medical history, perform a physical examination, and order diagnostic tests. 

Physical Exam

During the physical exam, your healthcare provider will look at your back, legs, and feet for signs of injury, infection, or inflammation. They will also ask you questions about your pain and may ask you to pinpoint exactly where you feel the pain.

Your provider may gently apply pressure on your calf to determine the most painful area. They will want to know whether you experience other symptoms and if any physical activities worsen your pain. Depending on the severity of your pain, they may ask you to walk to observe movement in your leg.

Testing

If the physical exam doesn't reveal what's causing your pain, your healthcare provider may suggest an imaging or blood test. Imaging scans take pictures of your bones, tendons, and other tissues in your calf to help identify anything concerning. X-rays help detect bone fractures. Computed tomography (CT), ultrasounds, and magnetic resonance imaging (MRI) scans also help identify potential health concerns.

Blood tests like the D-dimer blood test measure the amount of a protein fragment called D-dimer in your blood. D-dimer is only present when your body is making or dissolving a blood clot.

Blood tests can also measure your cholesterol level and check for markers of inflammation or infection. Your white and red blood cell count can also tell you more about what may be happening in your leg. A low white blood cell count may be a sign of a bone marrow condition or an autoimmune condition.

Treatment

Treatments may include self-care measures or medical treatments depending on the cause and severity of your pain. 

At-Home Treatments

Self-care measures can provide pain relief and, in some cases, such as muscle strains, may be sufficient for treating calf pain until the injury heals. The RICE method is a common pain treatment, which includes: 

• Rest: Limit or avoid activities that worsen calf pain for a day or two
• Ice: To relieve pain, apply an ice pack to your calf several times daily, up to 20 minutes at a time
• Compression: Wear a supportive brace or wrap an elastic bandage over your calf to keep pressure on the affected area and reduce inflammation and swelling
• Elevation: Elevate your foot and calf on a footrest or pillow to reduce swelling

Other at-home treatments that may relieve calf pain include: 

• Over-the-counter (OTC) medication: Pain relievers like Tylenol (acetaminophen) and Advil (ibuprofen) may offer temporary pain relief. 
• Stretching: Gentle calf stretches and light massage can help reduce muscle tightness. 
• Supportive footwear: Wear shoes with good arch support and cushioning.

Medical Treatments

Some causes of calf pain require additional treatment beyond at-home treatments and lifestyle changes. Medical treatments that may help intense calf pain include:

• Medications: Calf muscle injuries may require nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections. If a blood clot is causing calf pain, your provider may prescribe anticoagulants (blood thinners) to keep the blood clot from getting larger and prevent new ones. 
• Physical therapy (PT): A physical therapist can design a personalized exercise program to strengthen muscles and improve flexibility, reduce calf pain, and restore the normal range of motion in your muscles and tendons. 
• Immobilization: You may require a walking boot or cast to immobilize your leg and promote healing.
• Surgery: In rare cases, surgery may be necessary to treat conditions like a torn or ruptured Achilles tendon or severe compartment syndrome. 

A Quick Review

Calf pain has many possible causes, ranging from minor overuse injuries like muscle strain or tendonitis to more serious concerns such as blood clots and compartment syndrome. While rest and at-home treatments may be enough to treat some causes of calf pain, it's important to see a healthcare provider for pain that is severe, persistent, or occurs with symptoms like fever or swelling. 

They can advise you on preventing lingering pain in your daily life. This may include wearing supportive footwear or working with a physical therapist to help restore function in your leg and reduce the effect calf pain has on your day-to-day life.