What Causes Calf Pain?

The calf is the muscle located on the back of your leg, just below the knee. Though you may think of it as a single muscle, it’s actually made up of three: the gastrocnemius, soleus, and plantaris. Calf pain is often related to one or more of these calf muscles, but could also be secondary to an underlying medical condition. Your doctor or physical therapist is the best person to diagnose your calf pain.

Calf pain feels different from one person to another, largely depending on the cause. Some experience it as a dull, aching pain while others may experience it as a sharp pain or tightness. Soreness in the calf muscles is normal after an intense workout, but additional symptoms like swelling, paleness, numbness, or weakness could be cause for concern.

In this article, we’ll explore the subject of calf pain in greater depth to learn what it is, what causes it, and what you can do to treat and prevent it.

What Causes Calf Pain?

As previously mentioned, calf pain is often related to the muscles in the calf – generally due to injury or overtraining – but can also be caused by nerve damage, trauma, arterial disease, or another underlying medical condition. Let’s take a closer look at the common causes of calf pain.

  1. Muscle Cramps

A cramp occurs when one or more muscles contract involuntarily. Cramps are also known as Charley horses. A calf muscle cramp can be incredibly tight and intensely painful – you may also see a visible knot forming or the muscle twitching. Though it’s unclear exactly what causes muscle cramps, it could be related to post-exercise fatigue, dehydration, certain medications, or certain medical conditions.

  1. Muscle Strain

A muscle strain is usually the result of fatigue, overtraining, or improper use of a muscle. For example, you could strain your calf muscle when you first start running and push too hard. Muscle strains are usually noticeable when they occur and may involve pain, soreness, and limited range of motion. In mild to moderate cases, muscle strain can be treated at home with rest, ice, heat, and anti-inflammatories.

  1. Contusion

Also known as a bruise, a contusion occurs when the blood vessels under the skin tear or rupture. Blood can leak into the surrounding muscle tissue, causing the bruise to develop. Contusions usually occur during a fall or when you bump into something, or something strikes your calf. Rest and time is generally all that is necessary to heal a contusion.

  1. Rupture

If you suddenly place a lot of weight on your ankle while your knee is extended, you could rupture the plantaris muscle. It feels like a sudden, snapping pain on the back of the calf and may be accompanied by bruising, pain, and swelling in the following minutes, hours, or days. Some people experience cramping in the calf muscle following the injury, but it generally heals on its own with time.

  1. Achilles Tendonitis

The Achilles is the largest tendon in the body, located along the back of the leg, connecting the calf muscle to the heel bone. When the Achilles tendon becomes irritated, it is known as tendonitis. Achilles tendonitis may be accompanied by a burning pain in the back of the leg as well as calf pain and stiffness. When the Achilles tendon tears, it is called a rupture and it may require surgical repair.

  1. Diabetic Peripheral Neuropathy

Individuals with untreated or poorly managed diabetes are at risk for nerve damage called diabetic peripheral neuropathy. This condition is caused by chronic high blood sugar and may lead to muscle cramps and weakness, numbness in the extremities, loss of balance and coordination, and impaired sensation in the limbs.

  1. Deep Vein Thrombosis (DVT)

This condition is characterized by blood clots forming in the deep veins of the legs. Deep vein thrombosis can lead to redness, swelling, warmth, and a cramping pain in the calf. Conditions that may increase your risk for DVT include advanced age, pregnancy, obesity, sedentary lifestyle, cancer, or undergoing a surgical procedure.

  1. Arterial Claudication

Claudication is the term given to cramping pain during activity, generally caused by narrowed or blocked arteries in the leg. Claudication is generally noticeable in the buttocks, hips, thighs, calf, and/or foot when walking short distances but not during periods of rest.

  1. Compartment Syndrome

This is a serious and potentially life-threatening condition that occurs when a vast amount of pressure builds up inside a muscle compartment. It can happen after you fracture or break a bone and may cause symptoms like severe pain that doesn’t improve with rest, numbness, trouble moving the affected area, and a noticeable bulge in the affected muscle.

  1. Popliteus Tendonitis

The popliteus tendon connects the thighbone to the popliteus muscle by wrapping around the knee joint, working together with the muscle to rotate and stabilize the knee. When the popliteus tendon becomes inflamed (often due to overuse), it can cause pain in the calf as well as the back and side of the knee. In rare cases, this tendon can rupture – typically caused by some kind of trauma like a direct blow to the inside of the knee.

  1. Nerve or Artery Entrapment

This occurs when the nerves or arteries in the leg become compressed, restricting blood flow to the calf. Nerve entrapment, also known as a pinched nerve, can cause numbness, tingling, and sharp pain in the leg or the top of the foot. Artery entrapment usually affects the popliteal artery – the artery in the back of the leg and knee – and can develop over time or be present at birth (congenital). Symptoms of popliteal artery entrapment include tightness, cramping, and pain in the calf.

medically accurate 3d illustration of calf pain

Treatment Options for Calf Pain

The ideal treatment for calf pain depends on the underlying cause. If you’re experiencing new or worsening calf pain, it’s best to talk to your doctor – they’ll be able to perform a physical exam and review of your medical history and symptoms to make a diagnosis. If your doctor isn’t able to determine the cause of your calf pain, you may need to see a sports medicine doctor or orthopedist.

Depending on the cause of your calf pain, treatment options may include:

  • Protection – The first step in treating calf pain is to protect the area and prevent the condition from worsening. This may involve applying a bandage, splint, or immobilizer.
  • Rest – In addition to protecting the calf itself, you’ll want to rest the muscle by avoiding use as much as possible – this may involve crutches or a wheelchair to avoid using the affected leg.
  • Ice – Apply a cloth-covered ice pack to the affected area for 10 to 15 minutes at a time to help reduce pain and inflammation.
  • Compression – Wrapping your calf in a tight but stretchy bandage or wearing a compression stocking can prevent swelling.
  • Elevation – To promote circulation and reduce swelling, try elevating the affected leg on a few pillows while you’re resting.
  • Stretching – If your calf pain is related to muscle strain, stretching the muscle may help speed recovery and can help keep you from reinjuring your calf in the future.
  • Medications – Calf pain caused by muscle strain, contusion, or tendonitis can often be treated with non-steroidal anti-inflammatory medications (NSAIDs) which are available over-the-counter or by prescription from your doctor.

In extreme cases, surgery may be required for some causes of calf pain. A torn Achilles tendon may require surgical repair and a blocked artery in the leg won’t likely heal on its own. To diagnose your calf pain and determine the best course of treatment, your doctor may require blood or imaging tests.

Tips for Preventing Calf Pain

Once you’ve determined the underlying cause of your calf pain, there may be things you can do to prevent it from recurring in the future. Warming up properly before exercise, for example, can greatly reduce your risk of muscle strain or injury, as can cooling down and stretching after a workout.

Here are some additional tips to prevent calf pain:

  • Stay hydrated, especially during exercise. Drink plenty of water throughout the day, especially before, during, and after exercise. When working out, consider switching to a sports drink or something with electrolytes in it to help prevent cramping.
  • Give your body time to rest and recover. It’s normal to feel some soreness after a particularly long or intense workout, so give your body time to recover properly. If you work out several times a week, avoid working for the same muscle groups twice in a row – put at least 48 hours in between workouts of the same muscle group.
  • Undergo physical therapy to strengthen the muscles. After a muscle injury, it’s important to rebuild strength and stability which may require physical therapy. Your physical therapist will give you specific exercises to help you build back strength.
  • Make gradual changes to your workouts. Making sudden changes to your workout plan can increase your risk for muscle strain or injury, so be sure to make any changes gradual. If you’re not sure how quickly to make changes, consider working with a personal trainer.
  • Stretch before and after your workouts. After you’ve done a quick 5-to-10-minute warmup, do a few stretches to warm up your calf muscles before your workout. When you’re finished working out, cool down and then do a few more stretches.

If you exercise regularly, you probably have a pretty strong understanding of your own body. It’s important to trust yourself and to listen to your body, but don’t try to diagnose yourself when you experience calf pain. Some conditions that cause calf pain can be very serious, so if it’s anything other than typical post-workout soreness, you may want to seek medical attention just to be safe.

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