Calf Muscle Pain

Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board

Find out about the most common causes of calf muscle pain

Calf muscle pain is a common problem that can make walking, running and jumping difficult and painful.

Pain in the calf region may be due to injury, underlying medical condition or a problem in the nerves or arteries in the lower leg, meaning accurate diagnosis is vital. 

Whilst calf muscle pain is 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.

Common Causes of Calf Muscle Pain 

Let's start by looking at the most common causes of calf muscle pain, how they present and what causes them. 

Calf Tear

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

Partial or complete tear in one of the calf muscles from overstretching. Most common cause of calf muscle pain

Causes: Sprinting, sudden push off from stationary position, quick change of direction 

Symptoms: Instant calf muscle pain, bruising, swelling. If complete rupture, unable to push up onto tiptoes

Full Article: Calf Tears

Calf Cramps

Calf muscle pain is often caused by cramping in the muscle

Involutary spasms on the calf muscles which can be extremely painful. aka "Charley Horse"

Causes: imbalance of vitamins/minerals, muscle fatigue, diet, dehydration and muscle imbalance

Symptoms: Upper calf pain, tightness and spasming, difficulty walking. May last anything from a few seconds to a few days

Full Article: Calf Muscle Cramps

Bakers Cyst

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

Collection of excess fluid in the popliteal bursa behind the knee which can burst releasing fluid into the upper calf

Causes: Knee swelling from injury or underlying condition e.g. arthritis or gout

Symptoms: Swelling behind the knee, upper calf muscle pain, worse with activity, bruising around ankle

Full Article: Bakers Cyst Knee

Achilles Tendonopathy

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

Inflammation, degeneration or tearing of the inflexible achilles tendon. Most common cause of lower calf muscle pain

Causes: repetitive stress through the tendon, jumping , running, overstretching

Symptoms: lower calf pain, thickening in the achilles tendon, pain on tiptoes, ankle stiffness

Full Article: Achilles Tendonopathy

Other Causes of Calf Pain

So we've looked at the most common causes of calf muscle pain, but there are a few other less common causes of pain in the calf region.

Deep Vein Thrombosis (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. 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.

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. 

A trapped nerve can cause calf muscle pain, numbness and pins and needles

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.

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. 

Exercises are the best way to combat this and it important to get the right balance of strengthening and stretching exercises - visit the calf strengthening and calf stretching exercises sections for a whole range of exercises that will help combat this cause of calf muscle pain.

Peripheral Vascular Disease (PVD)

Also known as peripheral artery disease, this is when there is a narrowing in the arteries which slows blood flow. If this happens in the lower leg, it can cause calf muscle pain.

Peripheral Vascular Disease 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.

Calf Muscle Pain Treatment

The best calf muscle pain treatment will depend on the underlying cause of the pain. If there is damage to one of the calf muscles, then usually a combination of strengthening and stretching exercises alongside a course of physical therapy will be recommended. In more severe cases, such as a complete tear, then surgery may be required.

You can find out how to treat each of the calf muscle pain causes we have looked at here by using the links to navigate to the full articles on each condition.

Calf Pain With Activities

Calf Pain Walking
Calf muscle pain when walking is usually the result of reduced blood flow, and therefore lack of oxygen, to the calf muscles and usually settles down quickly with rest. Pain that persists even after resting may indicate a more serious problem such as peripheral vascular disease. 

Calf Pain In Runners
Calf pain running is typically caused by the muscles being overloaded. Any sudden increase in running activities, be it distance, speed, surface, or the introduction of speed or uphill work, can overload the calf muscles resulting in pain.

A lack of strength or endurance in the calf muscles is a common cause of calf pain in runners. A good test is to stand on 1 leg and push up onto your tiptoes then slowly lower back down. If you can do this 30 times on each leg, it indicates good calf muscle strength and endurance

Calf Muscle Twitching
A twitching sensation in the calf muscles often indicates benign fasciculation syndrome, a condition due to a harmless disorder of the nerves that activate the calf muscles. The calf muscle twitching usually stops when you use the calf muscle e.g. walking, but will often return when you rest.

Calf muscle twitching can also be the first sign of cramp, or that you have overworked the muscles. In rare instances, the twitching may indicate a more serious condition such as Lyme Disease, Multiple Sclerosis or Motor Neurone Disease.

Calf Pain At Night
It is very common to be more aware of pain at night as there are less distractions around. Calf muscle pain at night is often caused by nocturnal cramps which will usually wake you up. They tend to settle fairly quickly if you stretch the calf muscles.

Calf muscle pain at night can also indicate restless leg syndrome, where you have an overwhelming urge to keep moving your legs.

Calf Muscle Tightening
Tight calf muscles is usually the result of overuse such as long distance running, particularly if you don't warm up and cool down properly. Calf tightness can also develop after an injury, either in the calf itself or an ankle injury.

Stretching exercises focusing on each of the calf muscles, gastrocnemius and soleus, when done daily are usually the best way to overcome calf muscle tightening

Calf Muscle Knot
The technical term for calf muscles knots is myofascial trigger points. This is where a small area of muscle fibres and the underlying fascia tighten forming small lumps in the muscle, like a knot.

They may only hurt when you press on there, or in some cases they can cause pain at anytime for no obvious reason. Knots typically develop after a calf muscle injury but can also be related to poor posture, stress and prolonged inactivity.

Sudden Calf Pain
The most common cause of sudden calf pain is a calf muscle strain, where part of the calf muscle is overstretched causing it to tear. It typically occurs during sports and may be accompanied by bruising and swelling. Calf cramps can also develop very suddenly, either during activity or at rest.

Anatomy Of The Calf Muscles

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. 

Calf Muscle Pain may be caused by damage to the calf region or surrounding tissues

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.

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

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Page Last Updated: 09/24/19
Next Review Due: 09/24/21

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1. British Journal of Sports Medicine: Overview of exercise induced lower leg pain. January 2011

2. Physiotherapy Journal: Mechanical calf pain in a 23-year-old male due to dynamic functional entrapment of the popliteal artery. September 2005

3. Harvard Health Publishing: When walking makes your legs hurt - Four conditions for leg pain causes that can affect you when walking. August 2018

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