Calf Muscle Pain

Calf muscle pain is a common problem that can make walking, running and jumping difficult and painful. It can be due to injury, underlying medical condition or a problem in the nerves or arteries in the lower leg. 

Whilst often something minor like a grade one muscle strain, the problem may not actually be in the muscle itself and could be indicative of a serious problem such as a DVT so should always be treated with caution.

Here we start by look at the structures that make up the calf and then will go on to look at the most common causes of calf muscle pain, how the symptoms vary and how to spot a potentially serious problem.  

The calf is the area on the back of the leg between the knee and the ankle.  It is made up of two muscles collectively known as the triceps surae.  Triceps surae simply means “three-headed calf (muscle)”.  It comprises of a pair of muscles, gastrocnemius and soleus. 

The gastrocnemius muscle has two-heads which arise from either side of the bottom of the femur just above the knee joint. It is a superficial muscle, meaning it forms the top layer just below the skin.

The soleus muscle runs deep to (underneath) gastrocnemius and arises from the top of the tibia, just below the knee joint.  The two muscles join together around mid-calf level to form the Achilles tendon which twists and attaches the calf muscles to the back of the heel.

The triceps surae muscles work together to plantarflex the foot i.e. pull the foot downwards and stabilise the ankle.  They are particularly important in controlling and executing the push-off phase of walking and running.

Common Causes of Calf Muscle Pain

1) Calf Tear

Calf muscles pain is often caused by a tear in the muscle which it is overstretched

If the calf muscles are suddenly overstretched, some or all of the fibres may be torn, known as a calf strain or rupture.  This is the most common cause of calf muscle pain.  It usually happens whilst playing sports such as basketball, tennis and running where the person suddenly pushes off from a stationary position or has to change direction quickly which places a huge force through the muscle.

There are three grades of calf muscle strain, depending on the severity of the injury. Pain is usually instant and may be accompanied by swelling and/or bruising, although with a mild sprain symptoms might take a few hours to develop. If the muscle is completely ruptured walking will be very difficult. It can take anywhere from a few days to a few months for symptoms to settle down completely. 

To find out more about causes, symptoms and treatment options, visit the calf strain section.

2) Achilles Tendonitis

Achilles tendonitis can occur in different parts of the tendon, both causing calf pain

Inflammation or degeneration of the Achilles tendon commonly causes calf muscle pain.  The Achilles tendon is approximately six inches long, connecting the calf muscles to the heel.  The Achilles is extremely strong but not very flexible, making it prone to damage, especially if the calf muscles are weak and tight.

Achilles tendonitis usually causes pain in the calf or heel and there may be thickening in the tendon. The tendon has a poor blood supply so recovery can take months.  Treatment usually involves exercises, orthotics, rest from aggravating activities and injections.

Find out more about this common cause of calf muscle pain including causes and treatment options in the Achilles Tendonitis section on our sister site.

3) Calf Cramps

Commonly referred to as "Charley Horse" in North America, these are when involuntary spasms occur in the lower leg causing calf muscle pain.  Cramp may last for just a few seconds but in worst cases may continue on and off for a number of days. They are often caused by an imbalance of vitamins/minerals, muscle fatigue, diet, dehydration and muscle imbalance.  Whilst in most cases they aren't caused by anything too serious, they can be extremely painful.

The best treatments for calf cramps are exercises, particularly stretches, massage, good diet and supportive footwear.

To find out more about how cramp presents, common causes and top tips on how to treat them, visit the calf cramps section.

4) DVT

DVT's usually present with pain, swelling, redness and warmth in the calf region

A deep vein thrombosis can be a very serious cause of calf pain.  It is the formation of a blood clot in a deep vein, usually in the calf or thigh.  A DVT requires IMMEDIATE medical attention as it reduces the blood flow to the foot, and there is the risk that the blood clot could break off and travel through the bloodstream to the heart or lungs which can cause a heart attack or pulmonary embolus. 

The common signs of a DVT are pain, redness, warmth and swelling in the calf region, and the pain often gets worse if your dorsiflex your foot (pull your toes up towards you).  DVT’s often develop after surgery or periods of inactivity e.g. plane journeys, and there can be a genetic link.

5) Bakers Cyst

A Bakers Cyst is a collection of fluid behind the knee that often causes calf muscle pain

A Bakers Cyst is inflammation of the popliteal bursa (fluid filled sac) that sits behind the knee joint.  It can cause calf muscle pain, particularly if the cyst bursts resulting in the fluid tracking down the leg into the triceps surae. It is often accompanied by a squashy lump behind the knee.

Bakers Cysts are commonly associated with arthritis, but can occur for other reasons.  Visit the Bakers Cyst section to find out more including causes, symptoms and treatment options.

6) Muscle Imbalance

Muscle weakness and tightness is a common cause of calf muscle pain.   Weak muscles will tire quickly if you are on your feet for prolonged periods of time, so it is important to work on both strength and endurance. If the calf is tight, it is prone to damage from increased tension, making stretching exercises vital. 

You can find a whole range of calf strengthening and calf stretching exercises to help combat this, simply click on the links.

7) Trapped Nerve

Compression of the nerves of the lower leg can cause pain in the calf, pins and needles and numbness in the calf region.  The compression may be coming from the lower back where the nerve originates from, or at any point along the nerve itself.  Trapped nerves are usually accompanied by changes in sensation such as pins tingling or numbness and pain often spreads.  

Any symptoms of nerve compression, should be checked out by your doctor.  You can find out more in the nerve pain section on our sister site.

8) Peripheral Vascular Disease (PVD)

Also known as peripheral artery disease, this is when there is a narrowing in the arteries which slows blood flow.  It is commonly associated with smoking, diabetes, high cholesterol levels and high blood pressure.  In severe cases, the foot and lower leg may change colour – this warrants immediate medical attention.

To find out more about these common causes of calf muscle pain, including symptoms, diagnosis and treatment options, choose from the links above.

Safety Advice

Episodes of calf muscle pain should always be assessed by your doctor to ensure it is nothing serious such as a DVT which requires immediate attention.  Pay particular attention to the signs for a DVT: redness, swelling, warmth and pain around the calf. 

Also, calf muscle pain that is worse at night or makes it difficult to walk warrants immediate medical attention.

What Next?

To find out more about the most common causes of calf muscle pain, choose from the links above.  Alternatively, if you want some help working out what is causing your problem, visit the knee pain diagnosis section.

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