Common Causes of Lower Leg Pain and Treatment Options

Muscle Cramps

A muscle cramp is a sensation you get when you have an involuntary (not on purpose) muscle movement. The calf muscle is a common area for muscle cramps. This is often referred to as a "Charley horse."

Symptoms

Muscle cramps can be mild and feel like a tiny twitch. They can also be severe and intensely sharp or stabbing.

Muscle cramps in the lower leg can last anywhere from a few seconds to several minutes. Rarely, muscle soreness after a cramp may continue for days.

Causes

There are many causes of muscle cramps. Leg muscles normally contract (move) when calcium channels in the muscle fiber cause it to shorten in response to nerve stimulation—such as when you move your leg.

A cramp can happen if nerve stimulation triggers a muscle even when you don't want it to or if the muscle fiber shortens without nerve stimulation.

Factors that may increase your risk for developing muscle cramps include:

• Dehydration
• Mild alterations in electrolytes, especially calcium, potassium, sodium, or magnesium
• Exercising in extreme heat

Muscle tightness and fatigue can increase the likelihood of cramps.

Some health conditions may contribute to lower leg muscle cramps.

These conditions include:

• Diabetes
• Thyroid disease or liver disease
• Fibromyalgia
• Nerve or blood vessel disorders

Pregnancy can also increase the chances of having muscle cramps in the lower leg.

Statins are medications that lower your cholesterol. They may cause muscle cramps too.

Diagnosis

During your physical examination, your doctor may detect a tender muscle or a small lump. This is generally enough to diagnose muscle cramps.

If there's concern that you could have an underlying condition causing your muscle cramps, your healthcare provider may order blood or imaging tests. For example, you might have an electrolyte panel if you are at risk of dehydration or electrolyte imbalance.

Treatment

Treatment for leg cramps often involves:

• Gentle stretching and massage
• Hydration
• Applying heat

Sometimes doctors recommend you take oral magnesium and/or calcium.

Getting adequate treatment for any underlying medical condition is also key to easing your muscle cramps.

Muscle Strain

A strain is a common cause of leg pain. It's a muscle tear that often results from overstretching the muscle. The gastrocnemius muscle of the calf is a common area for strains and tears.

Symptoms

Muscle strains usually cause mild soreness. But you may also experience cramping or a sharp, tearing sensation. This is especially true if the strain is sudden or severe.

In addition to pain, swelling and bruising may also develop over the affected muscle.

Causes

Muscle strains may occur as a result of sudden trauma, such as a fall or a blow to the muscle.

A sudden change in direction, like when playing tennis or basketball, may also cause a calf muscle strain.

Overuse injuries involving the lower leg can also lead to muscle strains. Stressing a muscle again and again—for example, due to daily running—can cause damage.

Diagnosis

A medical history and physical examination are generally enough to diagnose a muscle strain in the lower leg. Your healthcare provider may also order an X-ray to rule out a bone fracture, especially if the pain is so severe that your leg movement is impaired.

Treatment

Doctors recommend the R.I.C.E protocol to treat a muscle strain.

In addition, your healthcare provider may also recommend that you take a nonsteroidal anti-inflammatory drug (NSAID). This can help control inflammation and pain.

Physical therapy may help you ease back into activity after your muscle strain heals.

Tendonitis

Tendonitis is inflammation surrounding a tendon, which is a strong, cord-like structure that anchors a muscle to a bone.

It is a common sports overuse injury, but it can affect anyone, regardless of activity level.

Common types of tendonitis that would cause lower leg pain around the ankle area are:

• Achilles tendonitis
• Posterior tibial tendonitis

Symptoms

Tendonitis causes pain that increases with movement of the affected tendon.

Other signs and symptoms may include:

• Swelling that worsens with activity as the day progresses
• Thickening of the tendon
• Morning stiffness

A sudden feeling of pain and/or "pop" at the back of your calf or heel indicates a potential Achilles tendon tear or rupture. If this occurs, seek medical attention right away.

Causes

A fall or sudden increase in the intensity or frequency of physical activity may cause tiny tears in the fibers that make up a tendon. These tiny tears trigger swelling and irritation.

Other factors increase your chances of developing Achilles tendonitis.

These factors include:

• Abnormalities in foot structure, such as flat feet or high arches
• Tight calf muscles
• Leg length differences
• Wearing improper or worn-out footwear
• Exercising outside in cold weather

Diagnosis

Diagnosis of tendonitis usually involves a medical history and physical examination.

Your doctor may also order imaging tests, like magnetic resonance imaging (MRI), to help to confirm the diagnosis and determine the severity of the injury.

Treatment

As with muscle strains, doctors recommend the R.I.C.E. protocol—rest, ice, compression, and elevation—for tendonitis.

Anti-inflammatory medications, physical therapy, and/or orthotics are also often helpful. Orthotics are custom, prescription medical devices worn inside your shoes to help maintain a healthy foot position to promote healing and reduce the risk of a traumatic injury.

Shin Splints

Shin splints, also known as medial tibial stress syndrome, refers to inflammation of the:

• Muscles
• Tendons
• Other tissues surrounding your shinbone, also called the tibia

Symptoms

The pain of shin splints may be sharp or dull. It's felt along the inside and back part of the tibia where the tibialis anterior muscle attaches to the bone.

The pain is usually felt during and after physical activity.

Causes

Shin splints are common exercise-related injuries. They often affect runners and people who participate in sprinting or jumping sports.

Shin splints may be aggravated or triggered by overpronation, which is when the ankle rolls too far downward and inward as you walk. It can be triggered by high-arched feet as well.

Improper or worn-out footwear can also increase your chances of developing shin splints.

Diagnosis

A medical history and physical examination are sufficient to diagnose shin splints.

Your healthcare provider may order imaging tests to rule out other conditions like:

• Stress fracture of the tibia
• Tendonitis
• Chronic exertional compartment syndrome

Treatment

Shin splints are extremely uncomfortable. But the good news is that you can follow simple steps to treat them.

These measures include:

• Stopping the activity that led to the shin splints: Try substituting the activity with a gentler exercise like swimming.
• Icing the area for 20 minutes several times a day: Be sure to place the ice in a towel or use a cold pack so there is no direct contact with your skin.
• Compressing the area with an elastic bandage: This is especially helpful if there's swelling.
• Stretching your lower leg muscles: This can help prevent inflammation and pain.

In addition, your healthcare provider may recommend medications like NSAIDs to ease pain and reduce inflammation.

Stress Fracture

A stress fracture is a tiny break in a bone. It can affect any bone, but it is especially common in the lower leg.

Symptoms

The hallmark symptom of a stress fracture is localized, sharp pain that improves with rest.

Causes

Stress fractures are overuse injuries. Basically, the muscles surrounding the bone become fatigued from using them too much. They eventually transfer the stress onto the bone. This leads to a tiny break.

A risk factor for this type of fracture is sports that place repetitive stress on the leg. Sports that involve running and jumping, like gymnastics, basketball, and tennis, may cause stress fractures.

Diagnosis

An X-ray is usually enough to diagnose a stress fracture in the lower leg.

But sometimes it's difficult for the doctor to see the fracture very well on an X-ray. Stress fractures may also not show up on an X-ray for several weeks.

In these cases, your healthcare provider may order a computed tomography (CT) scan or an MRI.

Treatment

The main treatment for stress fractures is rest, usually for six to eight weeks. Doctors also recommend placing ice on the injury.

To control the acute pain of a stress fracture, you can also use:

• Tylenol (acetaminophen)
• A low potency opioid such as Norco (hydrocodone/paracetamol)

Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a serious and potentially life-threatening cause of leg pain. It is a blood clot in a vein in the lower leg, and it can travel to the lungs, causing a pulmonary embolus.

Symptoms

In addition to cramping calf pain, other symptoms of a DVT in the lower leg include:

• Swelling
• Warmth
• Redness of the calf

Causes

A deep vein blood clot, called a thrombus, may occur as a result of an injury to the vein wall caused by a trauma or surgery.

It may also come from an underlying health condition that makes the blood more likely to clot, such as cancer or pregnancy.

Immobility, long hospital stays, and obesity prevent venous blood from flowing properly. All of these factors increase your risk for developing a DVT.

Diagnosis

Besides a careful medical history and physical examination, your healthcare provider can confirm the diagnosis of a DVT with an ultrasound.

Treatment

Treatment of a DVT involves taking an anticoagulant, or blood-thinning medication. This helps prevent the current clot from getting bigger and prevents new clots from forming.

Chronic Venous Insufficiency

The veins of the legs are vessels that return blood back to the heart. The valves inside the veins help direct blood flow and control pressure.

If the valves are not working properly, blood can flow backward into the veins and collect in the legs.

Over time, this can lead to increased venous pressure. This condition is called chronic venous insufficiency.

Symptoms

Some signs and symptoms of chronic venous insufficiency include:

• An aching or cramping leg pain
• Lower leg and ankle swelling
• Itchy, dry skin
• Patches of skin that are purple, dark red, or brown
• Hardened skin
• Presence of poorly healed wounds called venous ulcers, especially along the inner ankle
• Presence of varicose veins

Causes

Increased pressure in the veins can damage the valves and interfere with blood flow. This can cause chronic venous insufficiency.

For example, standing too long, obesity, and pregnancy can place additional weight and pressure on the veins in the legs. This may ultimately result in valve damage.

A history of leg trauma can lead to chronic venous insufficiency. A clot within a vein may block blood flow and damage the valves. This may also lead to chronic venous insufficiency.

Diagnosis

Diagnosis of chronic venous insufficiency involves:

• A medical history
• Physical examination
• A venous duplex ultrasound—an imaging test that uses sound waves to see how blood travels through your veins

Treatment

Treatment of venous insufficiency involves elevating the leg and wearing compression stockings.

Peripheral Artery Disease (PAD)

With peripheral artery disease (PAD), one or more leg arteries become narrow. This interferes with blood flow to the leg.

Symptoms

PAD is associated with a cramp-like pain in the calf, thigh, or buttock that's worse with activity. It feels better when you rest.

In addition to cramping pain, the affected limb can be cool, pale, and may have increased sensitivity to pain.

Other signs of PAV include:

• Lower leg wounds that do not heal
• Toenail changes
• Shiny skin
• Loss of hair near the area of the leg that is affected

Causes

Arterial narrowing occurs as a result of fatty deposit buildup within the artery's walls. This condition is called atherosclerosis.

Factors that increase a person's chance of developing PAD include:

• Cigarette smoking
• History of high cholesterol, high blood pressure, and/or diabetes
• Being at least 70 years old or more
• A lifestyle that does not involve exercise
• Known atherosclerosis in other areas of the body, like coronary artery disease or carotid artery disease

Diagnosis

Your doctor will begin your evaluation by inspecting your legs and examining your pulse.

To confirm a diagnosis of PAD, your doctor will also perform a test called the ankle-brachial index (ABI). This test measures the blood pressure of your ankle.

Imaging tests, such as an ultrasound, may also be used to take a closer look at the blood vessels in your legs.

Treatment

Treatment may involve lifestyle changes such as:

• Stopping smoking
• Starting a daily walking program
• Taking medication like aspirin or Plavix (clopidogrel) to thin your blood

It also involves getting underlying medical conditions, like diabetes, high blood pressure, and high cholesterol, under control with medication.

In more severe cases, angioplasty is necessary. During this procedure, the doctor uses an inflated balloon to open the blockage inside the artery. They then place a stent, which is a tube, into the artery to keep it open.

Bypass surgery may also be considered. With this, the surgeon uses a graft to re-route blood flow from a blocked artery.

Peripheral Neuropathy

Peripheral Neuropathy is when the nerves in the limbs are damaged.

Symptoms

Peripheral neuropathy causes decreased sensation in the limbs, generally affecting the toes before it progresses to involve the feet and lower legs.

It can also cause hypersensitivity, pain at rest, and weakness. The diminished sensation increases the risk of wounds, and the wounds can get worse or may get infected if they aren't well taken care of.

Causes

Peripheral neuropathy can occur as a result of uncontrolled diabetes, chronic alcohol use, vitamin deficiency, systemic inflammatory diseases, and more.

Diagnosis

A physical examination will generally show impaired sensation and diminished reflexes in the lower limbs. Hypersensitivity to touch can be part of this as well. Sometimes an EMG is used to confirm the diagnosis.

Treatment

Controlling underlying factors, such as alcohol intake, diabetes, and nutrition can help prevent peripheral neuropathy from getting worse. Sometimes the pain of peripheral neuropathy is severe, and treatment can help alleviate the pain.

Medications that are sometimes used to manage the pain of peripheral neuropathy include:

• Gabapentin
• Amitriptyline
• Nortriptyline
• Pregabalin

Lumbosacral Radiculopathy

Lumbosacral radiculopathy is often called sciatica. It refers to compression or irritation of one or more of the nerves that travel from your lower spine to your leg.

Symptoms

Lumbosacral radiculopathy causes an electric or shock-like pain in the:

• Lower back
• Buttocks
• Down the leg

Other symptoms of lumbosacral radiculopathy include:

• Numbness
• Tingling
• Burning sensations
• Weakness in the leg

Causes

Lumbosacral radiculopathy may be caused by a herniated spinal disc or irritation from a tight muscle, such as seen with piriformis syndrome.

Spinal stenosis occurs when the area around a person's spinal cord is narrowed. This may also lead to nerve compression in the lower spine.

Less commonly, an infection or tumor may be the cause of lumbosacral radiculopathy.

Diagnosis

In addition to a medical history and physical examination, your healthcare provider may order imaging tests such as an MRI or a CT scan to confirm lumbosacral radiculopathy and better understand its cause.

If imaging tests are not revealing, your healthcare provider may order an electromyography (EMG) and nerve conduction study.

Treatment

Treatment of lumbosacral radiculopathy often includes a combination of the following:

• Pain medication (e.g., an NSAID or opioid)
• Muscle relaxant
• Activity modification
• Epidural steroid injection
• Physical therapy

Surgery may be an option for people with persistent, disabling symptoms or those with cauda equina syndrome. This is a rare but very serious lumbar/sacral nerve condition that causes bladder, bowel, and/or sexual dysfunction.

Summary

Various medical conditions may cause leg pain. Visiting your doctor for a physical examination and imaging tests can help determine what's causing it. Treatment will depend on on the cause of your leg pain.

It's important to avoid self-diagnosing your injury or medical condition. Only a doctor can determine whether your condition is something that is a simple muscle strain or something more serious.