Causes of Calf Pain and Treatment Options

Everything you need to know about calf pain

Calf pain has several causes, from muscle injuries to chronic health conditions that affect blood flow and nerve function. They affect three muscles located in the back of your leg just below the knee: the gastrocnemius, soleus, and plantaris muscles.

In many cases, calf muscle pain while walking or a sudden calf pain at night may be as simple as a common "Charley horse" cramp. Other causes of calf pain are serious, and may be life-threatening if they aren't diagnosed and treated appropriately.

This article discusses calf pain causes, and when to be concerned about calf pain that needs to be seen by a healthcare provider. It also explains calf pain treatment, and strategies you can try to manage symptoms and prevent muscle-related calf pain in the future.

Causes of Calf Pain

Verywell / Joshua Seong

Types of Calf Pain

Calf pain can be broken up into two categories: pain that is related to the muscles, and pain that is not. Muscular pain often results from acute or chronic physical strain. These are the types of injuries that commonly happen in sports or other types of physical activity.

On the other hand, if you are having calf pain and you are not sure why, you may have an underlying condition that needs medical attention. Pain that is not muscle-related could be due to nerve damage, arterial disease, severe trauma, or something else.

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Click Play to Learn How to Treat and Prevent Calf Pain

This video has been medically reviewed by Oluseun Olufade, MD.

Muscle-Related Causes

An injury to the calf muscle can either happen suddenly (acute injury) or over time (overuse injury). Both are fairly common in sports that require quick bursts of movement, like tennis, soccer, or sprinting. Types of muscular calf pain range from cramps to tears.

Calf Muscle Cramp

A calf muscle spasm or cramp refers to a sudden, involuntary contraction of one or more calf muscles. These are often referred to as Charley horses.

Around 60% of adults experience Charley horses at nighttime, which last for an average of nine minutes per episode. Afterwards, your calf muscle may be sore for a few days.

Calf muscle cramps can be intensely tight and painful, and there may even be a visible knot or a twitching sensation. It is not exactly clear what causes them, though there are some theories:

  • Calf cramps may be linked to muscle fatigue following high-intensity exercise.
  • Some medications may induce them, such as Klonopin (clonazepam), Celebrex (celecoxib), Ambien (zolpidem), and Naprosyn (naproxen)
  • Certain conditions are associated with increased leg cramping, including coronary artery disease and cirrhosis.

Gastrocnemius Strain

A medial gastrocnemius strain is an acute injury that happens when the calf muscle is abruptly overstretched. It's what can cause a calf muscle to hurt due to small tears in the muscle fibers.

Gastrocnemius strains often happen during sports or exercise activities that involve sprints or jumps. It is one of the most common types of calf muscle strain.

Some people hear a "pop" when the injury occurs, and you may not feel pain in the moment. Usually, pain sets in after you take a few steps, and it can be described as a sharp or tearing sensation.

If the strain is severe, there may be swelling and bruising. In some cases, the pain may be too intense to walk.

Calf Muscle Contusion

A calf muscle contusion, otherwise known as a bruise, happens when blood vessels under the skin are torn or ruptured. As a result, the blood vessels leak into the muscle tissues.

This type of injury often occurs after a person falls, bumps into something, or is struck on the calf. Typically, a contusion leads to skin discoloration, along with tenderness or severe pain. Swelling may also limit your ability to move as you normally would.

With rest and rehabilitation, blood beneath the skin will reabsorb into your body as the contusion heals. However, contusions can occasionally lead to a hematoma—a pool of blood under the skin.

Most hematomas heal on their own. But in severe cases, your healthcare provider may order a surgical procedure to drain the blood, particularly if they suspect there is a risk of infection.

Soleus Muscle Strain

The soleus muscle plays an important role in lifting the heel off the ground. It also stabilizes your posture as you walk or run, preventing you from falling forward.

This muscle is particularly key for runners; consequently, soleus muscle strain is a common overuse injury in endurance running.

If you have a soleus muscle strain, you may feel deep soreness or tightness when you press on your Achilles tendon, walk on your tiptoes, or pull your toes toward your shin.

Many runners do not notice any particular incident that caused their soleus strain. Rather, symptoms tend to develop over time, beginning with calf muscle fatigue. Swelling, bruising, and sharp pain may worsen until it is too difficult to run at all.

Plantaris Muscle Rupture

Plantaris muscle ruptures happen when a lot of body weight is suddenly placed on the ankle while the knee is extended. You may feel a sudden, snapping pain in the back of your leg when the injury occurs.

Bruising, pain, and swelling may take a few minutes, hours, or even days to develop after the injury occurs. Some people may also have cramping in their calf muscle. Fortunately, this injury should also heal on its own.

How Long Does a Calf Strain Last?

The time it takes for a calf strain to heal will depend on which muscle is involved, and the type and severity of the injury. Adequate rest, while elevating the injury and applying ice, are among the fastest ways to relieve calf pain. Many calf strains heal on their own within a few weeks, but see your healthcare provider if you're not seeing improvement with home treatment.

Other Causes

While muscle injuries are the most common cause of calf pain, there are others that may stem from nerve problems, knee joint problems, or foot and ankle conditions. You are more likely to need medical attention or physical therapy if you have an injury in this category.

Achilles Tendinitis or Rupture

The Achilles tendon is the largest tendon in the body. It is located on the back side of your leg and connects your calf muscle to your heel bone.

When the tendon becomes irritated, usually due to overuse, you may feel a burning pain in the back of your leg, usually just above your heel. You may also have calf pain and stiffness. This is known as Achilles tendinitis.

A torn Achilles tendon is referred to as a rupture. When the tendon tears, you may have severe, sudden pain in the back of your leg. You may also have difficulty bearing any weight on your leg at all. Some people also hear a "pop" when the injury happens.

Blood Clot

Blood clots can form in the deep veins of the leg—a condition known as deep vein thrombosis. This can cause swelling, redness, warmth, and a tender, cramping pain in the calf.

Certain conditions increase a person's risk of developing a blood clot, such as:

  • Increasing age
  • Pregnancy
  • Obesity
  • Lack of physical activity
  • Cancer
  • Undergoing a recent surgical procedure

What Does a Blood Clot in the Calf Feel Like?

A blood clot is a very serious cause of calf pain that affects only one leg. It typically feels tender and painful, with redness and swelling. It also may feel warm or hot. Without treatment, the clot can sometimes travel to the lungs (pulmonary embolism) and be life-threatening.

Baker's Cyst

A Baker's cyst is not a true cyst. It is a collection of knee joint fluid that pools in the back of the knee. This is common in people who have arthritis.

If a Baker's cyst ruptures, the fluid may leak down into the calf region, causing an aching pain in the calf, along with swelling.

Nerve Entrapment

Nerve entrapment happens when calf nerves become compressed by the surrounding tissues. This is often referred to as a pinched nerve, and it can happen due to overuse or sudden trauma.

The nerve that is most prone to nerve entrapment is the peroneal nerve. When this nerve is pinched, you may feel numbness, tingling, and sharp pain in the leg or the top of the foot.

In severe cases, peroneal nerve entrapment can lead to foot drop—difficulty lifting the front of your foot due to muscle weakness.

Sciatica

A sciatica nerve, the largest in the body, is found at both the right and left legs. It sends nerve impulses back and forth between the leg and spine, and controls motor activity (motion) in your leg.

Sciatic nerve pain is very common and can affect the calf. As with many chronic pain conditions, some people find they have more calf muscle pain at night.

Sciatica pain is caused by a compressed nerve, so treatment is typically focused on resolving the pain through medication or sometimes surgery if pain persists. Treatment may also include physical therapy and acupuncture treatments.

Popliteus Tendinitis

The popliteus tendon wraps around your knee joint, connecting your thighbone to your popliteus muscle. Your popliteus tendon and popliteus muscle work together to rotate and stabilize your knee.

Popliteus tendinitis happens when the tendon is inflamed, usually due to overuse. It causes pain just above the calf and in the back and side of the knee. The pain worsens when walking or running downhill.

In rare cases, the popliteus tendon can also tear. This is an acute injury that is usually caused by trauma, such as a direct blow to the inside of the knee. The injury causes pain and bleeding into the knee joint.

Popliteal Artery Entrapment

Popliteal artery entrapment happens when the gastrocnemius muscle places pressure on the popliteal artery—an artery in the back of the leg and the knee. This can restrict blood flow in the legs.

The condition may be congenital (present at birth) or it may develop over time. It is commonly seen in young athletes, as their popliteal artery becomes compressed while their body is still growing.

The symptoms of popliteal artery entrapment can include cramping, tightness, and pain in the calf, particularly after a vigorous lower leg workout, such as cycling or running.

Peripheral Arterial Disease and Claudication

Peripheral artery disease can reduce blood flow in the arteries of the lower legs, leading to claudication (cramping pain during activity). This is due to narrowed or blocked arteries in the mid-thigh or the knee.

With claudication, you may feel pain in your buttock, hip, thigh, calf, and/or foot upon walking short distances. Some people experience pain in their leg while lying in bed at night—this is a sign that the condition is getting worse.

Lower Leg Bone Fracture

A bone break or fracture in one of your lower leg bones (the tibia or fibula) may be caused by falling or by a traumatic blow to your leg, such as a car accident.

This injury may cause severe calf pain. Additionally, your lower leg may be quite swollen, making it difficult to walk or bear any weight on your leg.

A complete bone break can cause your leg to look deformed. This can also happen if the broken bone does not heal properly. To prevent this from happening, you may need a cast or, in some cases, surgery.

Bone Infection

Bone infection (osteomyelitis) is rare. It is usually caused by a bacterial infection that spreads to the bone. This infection may start in the bone itself or spread to the bone after an injury, such as a fracture.

With this condition, you may have constant, dull calf pain. There may also be a sensation of warmth along with redness and swelling in your leg. Some people develop a fever.

Conditions that affect your legs' arteries, nerves, tendons, muscles, or bones can cause calf pain. Some non-muscle related injuries are life-threatening; go to a hospital if your pain starts suddenly without any apparent cause.

When to See a Healthcare Provider

If you're not sure what your calf pain is a symptom of, or if you do not know how to treat your condition, you should contact your healthcare provider. Your treatment will depend on the specific cause of your calf pain.

Some signs that you should be seen by a healthcare provider include:

  • Inability to walk comfortably on the affected side
  • Injury that causes deformity of the lower leg
  • Calf pain that occurs at night or while resting
  • Calf pain that persists beyond a few days
  • Swelling of the calf or ankle joint area
  • Signs of an infection, including fever, redness, warmth
  • Any other unusual symptoms

Diagnosis

To diagnose your calf pain, a healthcare provider will likely perform a physical exam and ask you about your medical history. They may also order imaging tests, such as an X-ray, ultrasound, or magnetic resonance imaging (MRI). Sometimes, blood tests also are needed.

Medical History

Prior to your healthcare provider's visit, it's a good idea to jot down a couple notes about your calf pain. You may write about when it started, what it feels like, and whether you have any other symptoms like numbness or swelling. These details will help your healthcare provider pinpoint the cause.

In addition to asking about the specifics of your calf pain, your healthcare provider will want to know if you have any health problems. Be sure to tell them about any recent injury or trauma you may have had.

Physical Examination

During the physical exam, your healthcare provider will inspect and press on (palpate) your lower leg in order to look for signs of swelling, tenderness, warmth, and discoloration or redness. They may also check your reflexes and feel for your pulse in your leg, ankle, and foot.

Lastly, they will maneuver your foot, ankle, and knee to see how well you're able to move it. They will likely perform other special tests if they suspect a certain diagnosis.

An example of a special test that healthcare providers use to evaluate calf pain is the Thompson test.

For this test, the patient lies flat on an exam table with their foot hanging over the edge. A healthcare provider will then squeeze the patient's calf muscle. If the patient's toes do not flex downward when the calf is squeezed, the healthcare provider may suspect an Achilles tendon rupture.

Blood Tests

In most instances, blood tests are not needed to diagnose calf pain.

That said, a D-dimer test may be ordered to help diagnose a blood clot or pulmonary embolism. D-dimers are fragments of proteins the body produces as it breaks blood clots down, so a positive test means there may be a blood clot in your body.

To check for a bone infection, a blood test may be used to measure erythrocyte sedimentation rate (ESR). A faster-than-normal ESR means that your immune system has triggered inflammation.

A blood test may also be used to measure levels of C-reactive protein (CRP)—a protein produced by the liver when there is inflammation in your body.

Imaging

When diagnosing calf pain, healthcare providers may use various imaging tests. X-rays can reveal many types of abnormalities of the lower leg, ankle, or knee, particularly problems with bones and joints.

An ultrasound or MRI may be used to evaluate calf tendon injuries and tears. In some cases, imaging tests can also be used to check for blood clots.

If your healthcare provider suspects a blood clot, they may order a vascular study to confirm the diagnosis. This type of ultrasound is used to check the blood flow in your veins and arteries.

Treatment

Treatment for your calf pain depends entirely on the cause of the problem. Some conditions that cause calf pain can easily be confused for others. For this reason, you should visit your healthcare provider for a diagnosis before starting a treatment program on your own.

Surgery is rarely needed to treat calf pain, but it may be necessary for more severe injuries, such as a torn Achilles tendon or a blocked popliteal artery that won't heal on its own.

Below are some common initial treatments that your healthcare provider may suggest.

Rest

The first treatment, in most cases, is to rest the muscles and allow the acute inflammation to lessen. This is often the only step needed to relieve calf pain. If symptoms are severe, a walking boot and crutches may be helpful.

Ice and Heat

Ice packs and heating pads are among the most commonly used treatments for muscle or tendon-related calf pain. Depending on your situation, one may be better to use than the other.

Stretching

Stretching the muscles and tendons of the calf can help with some causes of calf pain. It's important to stretch regularly and use proper technique to prevent further injuries. Consult with a physical therapist to learn a stretching routine that suits your injury.

Physical Therapy

Physical therapy is an important part of treatment for almost all orthopedic conditions. Physical therapists use different techniques to increase strength, regain mobility, and help return patients to their pre-injury level of activity—or as close to it as possible.

Medications

Nonsteroidal anti-inflammatory medications (NSAIDS) are some of the most commonly prescribed medications, especially for patients with calf pain caused by tendinitis or a muscle strain, contusion, or cramp.

Less commonly, a cortisone steroid injection may be used to treat certain sources of leg or calf pain.

If you are diagnosed with a blood clot, you will likely be placed on a blood thinner, also referred to as an anticoagulant. Examples of anticoagulant drugs include Coumadin (warfarin) or Xarelto (rivaroxaban).

These medications prevent your current blood clot from getting bigger, and they also prevent new clots from forming.

Prevention

There are some lifestyle habits you can adopt to prevent many causes of calf pain, especially the muscle-related ones.

In order to prevent muscle cramps and strains in your calf, it's important to warm up. For example, your warm-up may include jumping jacks or gently jogging in place. The point is to ease your muscles into activity rather than starting suddenly.

After your workout, it's important to cool down. This means slowing down your activity for at least 10 minutes before stopping completely.

When it comes to preventing muscle cramps, one of the best things you can do is stay hydrated. You should also avoid over-exercising, especially in very hot weather or rooms.

Drinking an electrolyte drink or taking an electrolyte tablet—which contains potassium, magnesium, and calcium—may help stave off muscle cramps. This is because dehydration can cause calf pain. You should also limit alcohol and caffeine intake. Both are diuretics, which means they dehydrate you.

Preventing blood clots, claudication from peripheral artery disease, and other conditions related to blood flow is not as straightforward. But there are things you can do to minimize your chances of developing them, such as:

  • Stopping smoking
  • Maintaining a healthy weight
  • Taking your medications as prescribed
  • Seeing your primary care provider for regular check-ups and screening tests (e.g., diabetes and cholesterol)

Summary

Calf pain can be caused by injuries to muscles, bones, or tendons as well as infections or conditions that affect blood flow. Your healthcare provider may diagnose the pain using imaging tests or blood tests.

Depending on your diagnosis, they may suggest medication, rest, or physical therapy. You may also be able to prevent calf pain by warming up and cooling down when exercising, staying hydrated, and making healthy lifestyle choices.

A Word From Verywell

You may be tempted to self-diagnose your calf pain or treat it on your own instead of visiting a healthcare provider. The problem with that is that some conditions—like blood clots—are serious, and require urgent management. Be good to your body and see your healthcare provider. In many cases, some rest, ice, and a pain reliever may be all you need to get back to your normal routine.

Frequently Asked Questions

  • What causes calf pain that happens in the morning?

    There may be more than one reason for calf pain in the morning, but it's common for joint and muscle pain to occur in the morning due to inactivity during your sleeping hours. This is sometimes called "startup" pain and can affect the knees and feet as well.

  • Can bad knees cause calf pain?

    Yes. A number of knee problems can strain the muscles and tendons that run along the calf. A common issue is a Baker’s cyst, a complication of arthritis in the knee joint. If you have swelling and redness behind the knee, it might be a sign of a cyst, which is a sac filled with fluid.

  • How do I take care of a pulled calf muscle?

    The first step is to follow the RICE method. RICE stands for:

    • Rest
    • Ice
    • Compression
    • Elevation

    Don’t apply heat or massage the area initially. Don’t walk or strain the muscle. If the pull is severe, you'll need surgery, so it’s best to have the injury checked by a doctor.

  • What deficiency causes calf pain?

    Several vitamin and mineral deficiencies can lead to cramping calf pain, including vitamins B12 and D3. Low iron levels and electrolyte imbalances also may contribute to calf pain.

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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.