Calf pain is often caused by muscle cramps or strains. More serious conditions such as blood clots & diabetic neuropathy can also cause upper & lower calf pain.
7 most common cause(s)
Calf pain symptoms
Call it a Charley Horse or, more likely, yelp in pain that you have a Charley Horse. Many of us suffer from leg cramps or experience calf pain from time to time. Calf pain can be caused by a number of conditions from electrolyte deficiency and dehydration, to over-exercising, to edema.
Common accompanying symptoms of calf pain
The symptoms that are often associated with calf pain include:
- Cramps in the calf area
- Feeling of a muscle strain in the calf
- Swelling of the calf
- Tightness in the back of the leg
- Unusual heat/unusual cold in the back of the leg
- Tingling in the calf muscle area
- Sharp pain
- Weakness in the leg
- Fluid retention
- Numbness
- Loss of balance or coordination
Calf pain usually presents with a sharp pain or even a dull aching pain with some tightness at the back of the leg, in the calf muscle area. Most times, calf pain is not a sign of a serious condition; however, it could be a sign of an underlying condition that causes swelling, tingling, and pain in that area of the leg including diabetes or sciatica.
Calf pain causes
Calf structure
To understand calf pain, it helps to understand how the muscles are constructed here. The calf is actually comprised of two muscles of the leg: the gastrocnemius and the soleus.
Both muscles meet at the Achilles tendon, which attaches these muscles to the heel. Every time you move your leg or foot, you must use all of these muscles. Therefore, any strain to any one of these muscles when walking, jogging, lifting weights, or performing any type of exercise could contribute to calf pain.
Structural causes of calf pain
Issues among the structures that allow for normal calf functioning may result in calf pain.
- Muscle cramps: Muscle cramps are often a sign of dehydration or an electrolyte deficiency of magnesium or potassium. Getting more of these nutrients often helps alleviate leg cramps as well as drinking more water.
- Muscle strains: Muscle strains are often caused by fatigue, injuring a muscle, overtraining, or overuse of the calf muscles. Lifting more weight than usual with your legs, moving heavy furniture, carrying large, heavy loads, starting a new job with lots of standing involved, all of these can cause muscle strains.
- Achilles tendonitis: Achilles tendonitis is caused by strain to the Achilles tendon, which causes pain, swelling, and inflammation in the Achilles tendon. This can also cause pain in the connected calf muscles as well.
- Sciatica: The sciatic nerve runs all the way down the lower leg and to the back of the knee. Any issues with this nerve will cause pain in the calf muscle area, which is typically accompanied by numbness and tingling all along that area. In some cases, pain is so severe that surgery is required to alleviate it.
Bruising
A bruise is typically a result of a fall, bump, scratch, or sudden trauma to an area. If the calf is bruised, this could cause a lot of calf pain. Any bruises that have no causes or explanation should be examined by a doctor. Unexplained bruising could be a sign of a serious underlying disorder.
Medical conditions
Other medical conditions, often serious, can result in calf pain.
- Diabetic neuropathy: Diabetes, in its late stages, begins to affect the nerves and blood vessels of the leg. Diabetic neuropathy is a type of nerve damage that affects the feet, legs, and hands. This condition is a common complication of diabetes resulting from overexposure to high blood sugar, genetic factors, or nerve inflammation.
- Deep vein thrombosis: Deep vein thrombosis (DVT) is a blood clot that forms, typically in the arm or leg, and most often in the calf and thigh. Other symptoms include edema-like swelling of the limb, warmth in the limb affected, and skin discolorations in the limb affected. DVT is serious, as blood clots could move and travel to other parts of the body, most commonly the lungs (pulmonary embolism) — a potentially life-threatening condition.
This list does not constitute medical advice and may not accurately represent what you have.
Repetitive strain injury of the calf
Repetitive strain injury of the calf is caused by consistent repetitive use.
Rarity: Uncommon
Top Symptoms: lower leg numbness, calf pain from overuse
Symptoms that always occur with repetitive strain injury of the calf: calf pain from overuse
Symptoms that never occur with repetitive strain injury of the calf: recent calf injury, severe calf pain
Urgency: Self-treatment
Achilles tendon rupture
The Achilles tendon connects the calf muscles to the heel bone. Together, they help push the heel off the ground and let a person go up on their toes. If the Achilles tendon stretches too far, it can tear or rupture.
Rarity: Rare
Top Symptoms: achilles tendon pain, constant foot pain, sports injury, recent ankle injury, swollen achilles
Symptoms that always occur with achilles tendon rupture: achilles tendon pain
Urgency: Hospital emergency room
Peripheral arterial disease (PAD)
Peripheral artery disease (PAD) is a chronic condition that reduces blood flow in the arteries, usually arteries that lead to the legs. This reduced blood flow happens when clumps of fat (called plaques) build up inside these arteries, causing them to narrow. Symptoms include leg numbness, foot and thigh pain, cold feet, and muscle fatigue. These symptoms often occur when walking or exercising. The risk of developing PAD is higher in those who smoke or have diabetes. High blood pressure, high cholesterol, being overweight, and not getting much exercise also can put one at higher risk.
You should consider visiting a healthcare provider in the next two weeks to discuss your symptoms. Your provider can evaluate PAD with a review of your symptoms and a physical exam. An MRI may be performed as well. Once diagnosed, treatment involves medication, surgery, or procedures to open or bypass blocked arteries. Lifestyle changes regarding diet, exercise, and smoking cessation may also help.
Rarity: Common
Top Symptoms: leg numbness, spontaneous foot pain, decreased exercise tolerance, cold feet, thigh pain
Symptoms that never occur with peripheral arterial disease (pad): calf pain from an injury, thigh pain from an injury
Urgency: Primary care doctor
Diabetic neuropathy
Diabetic peripheral neuropathy is the damage done to nerve fibers in the extremities by abnormally high blood sugar. Anyone with diabetes is at risk for peripheral neuropathy, especially if the person is overweight and/or a smoker.
Symptom include pain, numbness, and burning in the hands, arms, feet, and legs; muscle weakness; loss of balance and coordination; and infections, deformities, and pain in the bones and joints of the feet.
Peripheral neuropathy can develop very serious complications, since the high blood glucose prevents any infection or damage from healing as it should. This can lead to ulcerated sores, gangrene, and amputation. For this reason, signs of peripheral neuropathy are considered a medical emergency and the person should see a medical provider as soon as possible.
Diagnosis is made through sensitivity tests and nerve conduction studies.
There is no cure for diabetic neuropathy, but the symptoms can be managed in order to slow the disease and help restore function. Treatment will include lifestyle improvements and the use of pain medication.
Deep vein thrombosis
A deep vein thrombosis (DVT) occurs when a blood clot forms in a vein deep in the body, usually in the lower leg or thigh. DVT can cause swelling, pain, and redness in the affected leg. Some of the risk factors for developing DVT include obesity, pregnancy, cancer, surgery, and previous history of blood clots.
You should consider calling your primary care or urgent care provider. Deep vein thrombosis can be evaluated with a review of your symptoms, a physical exam, and an ultrasound. A blood test may also be performed. Once diagnosed, DVT can be treated with blood-thinning medication, which is usually taken for three months.
Rarity: Uncommon
Top Symptoms: fever, thigh pain, upper leg swelling, calf pain, butt pain
Urgency: Hospital emergency room
Calf strain
A strain, commonly called a "pulled muscle," is when a muscle becomes overstretched, and microscopic tears occur. A calf strain happens when one of the muscles on the back of the lower leg is pulled.
You can safely treat this condition on your own. A muscle strain can be treated with rest, ice, compression, and pain medication.
Rarity: Common
Top Symptoms: pain in one calf, moderate calf pain, calf pain, sports injury, soccer injury
Symptoms that always occur with calf strain: pain in one calf
Urgency: Self-treatment
Calf bruise
A bruise is the damage of the blood vessels that return blood to the heart (the capillaries and veins), which causes pooling of the blood. This explains the blue/purple color of most bruises. Bruises of the calf are common, given the location on the body.
You can treat this at home with R.I.C.E - rest (exercise as tolerated), ice (10-20 minutes at a time), compression (this is pretty optional), and elevation (put your feet up to help blood flow back to the heart using gravity).
Rarity: Uncommon
Top Symptoms: pain in one calf, recent calf injury, calf pain from an injury, swollen calf, bruised calf
Symptoms that always occur with calf bruise: recent calf injury, calf pain from an injury
Urgency: Self-treatment
Baker's cyst (popliteal cyst)
A Baker's cyst, also called as Popliteal cyst, is a fluid-filled mass that causes a bulge and a feeling of tightness behind the knee. The pain can get worse when the knee is fully flexed or extended.
Although a Baker's cyst may cause swelling and make you uncomfortable, treating the probable underlying problem (i.e. knee arthritis) usually provides relief. Your doctor will be able to determine whether surgery, though unlikely, is needed.
Rarity: Uncommon
Top Symptoms: calf pain, swollen knee, knee pain that gets worse when squatting, knee instability, dull, achy knee pain
Symptoms that always occur with baker's cyst (popliteal cyst): lump on the back of the knee, constant knee lump
Urgency: Primary care doctor
Achilles tendonitis
Non-insertional Achilles tendinitis is an inflammation of the center section of the Achilles tendon. It runs down the back of the ankle and connects the calf muscle to the heel bone.
Overuse, especially without proper conditioning, causes the small fibers of the tendon to become weakened, torn, and broken down. The tendon becomes thickened, swollen, and sometimes calcified in an attempt to protect itself.
Non-insertional Achilles tendinitis is most common in younger people, especially those in training for sports or the military.
Symptoms include stiffness, pain, and firm, tough swelling at the back of the ankle up above the heel; pain that is worse after exercising; and difficulty flexing or rotating the ankle.
Tendons do not heal very well, so treatment is important to ease the symptoms and repair as much of the damage as possible.
Diagnosis is made through physical examination and x-rays.
Treatment involves rest, ice, nonsteroidal anti-inflammatory drugs, and physical therapy. Specialized shoes and inserts can help take the pressure off of the injured tendon. Surgery is sometimes tried.
Calf pain treatments and relief
At-home treatments for calf pain
Calf pain caused by trauma, a pull, or a moderate injury of some kind can typically be eased with the following methods.
The RICE (Rest, Ice, Compression, Elevation) method is advised by all healthcare practitioners and anyone working at a hospital when they send you home with a pulled calf, tendon, or even a broken bone in some areas of the body.
- Rest: First, rest the area — meaning don't add insult to injury. Try not to use the injured leg.
- Ice: Applying cold ice packs to the area can reduce inflammation and pain.
- Compression: Use a leg brace or compression sock to reduce swelling and prevent any risk of blood clots.
- Elevation: Elevating the calf above the level of your heart will get swelling and inflammation to decrease.
Further treatments for calf pain
If your calf pain worsens or persists, you should consult your physician who may recommend the following.
Questions your doctor may ask about calf pain
- Did you injure your calf?
- Did you just suffer from a high impact injury (e.g., a fall, collision, accident or sports trauma)?
- Do you have any idea what caused your calf pain
- Have you ever been diagnosed with diabetes?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
FAQs about calf pain
Can alcohol cause calf pain?
Yes, if alcohol is consumed over a long period of time it can cause an alcoholic neuropathy. This means the consumption of alcohol can damage the nerves within the body. This damage starts with the longest nerves in the body which tend to service the limbs, arms or legs. Alcohol in high concentrations can kill neurons and tends to damage the longer neurons, first affecting the limbs. It may manifest as burning, pain, or cramping sensations in the legs.
Do blood clots lead to calf pain?
Blood clots can lead to calf pain depending on where they occur, especially if they they completely block blood flow to the affected leg. In some cases, a large blood clot can be painful and create a tender area on the calf. A leg with a dangerous clot, called a deep vein thrombosis (DVT), may be warmer than usual with redness or tenderness to the touch. It may have pain tracking on the pathway of major veins in the setting of an infection as well. If you have swelling of one leg, warmth, a tendency to clot, especially after sitting for a long car or plane ride, you should seek medical evaluation.
Why do my calves ache at night?
Restless leg syndrome is a common cause of leg pain or itchiness or discomfort at night that is alleviated by movement of the legs. It is much more common at night and may lead to sleep disturbances that impair functions during the day. It may cause jerking movements of the legs during the night commonly known as periodic leg movements.
Why are my calf muscles so tight?
Calf muscles can be tight for many reasons. One of the most common reasons for increased calf tightness is increased exertion of calves during the day. Commonly, shoes with a lift (e.g. high heels, wedges, etc.) can cause tightness of the calf muscles, especially if on their feet throughout the day. Additionally, any activity that involves using the calf muscles to flex the foot downward, like standing on the toes or pressing the accelerator of a car, can lead to calf tightness.
Can dehydration cause calf pain?
Dehydration can increase the chance of cramping for any muscle that is vigorously exercised. This includes muscles that are commonly used like hamstrings, quadriceps, or calves. If you are engaging in physical activity that takes advantage of calf muscles and you have not hydrated properly, it is possible to develop cramps in your calf muscles.
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References
- Causes of Calf Pain. Institute for Preventive Foot Health. IPFH Link
- Ma CB. Sciatica. U.S. National Library of Medicine: MedlinePlus. Updated November 13, 2018. MedlinePlus Link
- What is Diabetic Neuropathy? National Institute of Diabetes and Digestive and Kidney Diseases. Published February 2018. NIDDK Link
- Deep Vein Thrombosis. American Academy of Orthopaedic Surgeons: OrthoInfo. Updated June 2015. OrthoInfo Link
- Chopra K, Tiwari V. Alcoholic Neuropathy: Possible Mechanisms and Future Treatment Possibilities. British Journal of Clinical Pharmacology. 2012;73(3):348-362. NCBI Link