Common Causes of Lower Leg Pain and Treatment Options

 Common Causes of Lower Leg Pain and Treatment Options

Lower leg pain is common, but it can be tricky sorting out its many potential causes. While factors like what your pain feels like—stabbing, burning, or cramping, and so on—can provide insight, oftentimes, a detailed physical examination and/or an imaging test are needed to clinch the diagnosis.

Here is a summary of the most common lower leg pain conditions, ranging from muscle and bone to blood vessel and nerve problems.

Remember: It's best to not self-diagnose, especially if your leg pain is severe, sudden, accompanied by swelling, or if you have an underlying health condition like diabetes or a circulation problem.
Muscle Strain

A strain is a common cause of leg pain and results from an overstretching of a muscle that sometimes leads to a tear. The gastrocnemius muscle of the calf is a common area for strains and tears.

While muscle strains usually cause mild soreness, you may also experience cramping or a sharp, tearing sensation, especially if the strain is sudden and/or severe. In addition to pain, swelling and bruising may also occur over the affected muscle.

Muscle strains may occur as a result of sudden trauma, like a fall or a blow to the muscle. Overuse injuries to the lower leg can also lead to muscle strains. More specifically, a sudden change in direction, like when playing tennis or basketball, may result in a calf muscle strain.

While a medical history and physical examination are generally sufficient to diagnose a muscle strain in the lower leg, your doctor may order an X-ray to rule out a concomitant bone fracture.

The R.I.C.E protocol is recommended for the treatment of a muscle strain. This includes resting the muscle, applying ice to the painful area several times a day, compressing the muscle with an elastic bandage, and elevating the lower leg above the heart (to reduce swelling).

In addition, your doctor may also recommend taking a nonsteroidal anti-inflammatory drug (NSAID) to soothe the acute inflammation. Physical therapy can help a person ease back into their exercise regimen after a muscle strain.1
Shin Splints

Shin splints, also known as medial tibial stress syndrome, refers to inflammation of the muscles, tendons, and other tissues surrounding your shinbone (tibia).

The pain of shin splints may be sharp or dull and is felt along the inside (medial) and back (posterior) part of the tibia where the calf muscles attach to the bone. Usually, the pain is felt during and after physical activity.

Shin splints is a common exercise-related injury, often affecting runners and those involved in sprinting or jumping sports. In addition, shin splints may be aggravated or triggered by foot conditions such as overpronation or high-arched feet. Improper or worn-out footwear can also increase your chances of developing shin splints.

A medical history and physical examination are sufficient to diagnose shin splints. However, your doctor may order imaging tests to rule out mimicking conditions like a stress fracture of the tibia, tendonitis (see below), or less commonly, chronic exertional compartment syndrome.

While shin splints can be quite unpleasant, the good news is that simple measures can be used to treat them.2

These measures include:

Stopping the activity that led to the shin splints (often for weeks). 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 the ice on your skin.
Compressing the area with an elastic bandage. This is especially helpful if swelling is present.
Stretching your lower leg muscles. This will help soothe your shin splints.

In addition, medications like NSAIDs may be recommended by your doctor to ease pain and reduce inflammation.

Tendonitis is a common sports overuse injury but can strike anyone, regardless of activity levels. Tendonitis is inflammation surrounding a tendon, which is a strong, cord-like structure that anchors a muscle to bone.

Common types of tendonitis that would cause lower leg pain around the ankle area are Achilles tendonitis and posterior tibial tendonitis.3

Tendonitis causes pain that increases with activity or stretching of the affected tendon. Other signs and symptoms may include swelling that worsens with activity as the day progresses, thickening of the tendon, and morning stiffness.

A sudden pain and/or "pop" at the back of your calf or heel indicates a potential Achilles tendon tear or rupture. In this case, be sure to seek medical attention right away.

Trauma, such as from a fall, or sudden increases in the intensity or frequency of physical activity may lead to tiny tears in the fibers that make up a tendon. These tiny tears trigger swelling and irritation.

More specifically, in addition to trauma and overuse or repetitive motions, other factors that increase your chances for developing Achilles tendonitis include:

Abnormalities in foot structure such as flat feet or high arches
Tight calf muscles
Leg length discrepancy
Wearing improper or worn-out footwear
Cold weather training

Diagnosis of tendonitis usually involves a medical history and physical examination. Imaging tests, like a magnetic resonance imaging (MRI), may be ordered to confirm a diagnosis of tendonitis and/or to access the severity of the tendon tear.

The R.I.C.E. protocol (rest, ice, compression, and elevation) is also recommended for this condition. Anti-inflammatory medications, physical therapy, and/or orthotics are also often helpful.
Muscle Cramps

A muscle cramp is a contraction of a muscle that is sudden and out of your control. The calf muscle is a common area for a cramp to occur (often referred to as a "charley horse.")

Muscle cramps can be mild and feel like a tiny twitch or be severe and intensely sharp or stabbing. Keep in mind, while muscle cramps in the lower leg can last anywhere from a few seconds to several minutes, muscle soreness may continue for days.

It's not totally clear why muscle cramps develop, although experts suspect that tight and fatigued muscles lead to abnormalities in the processes that normally control muscle contraction.

Additional factors that may increase your risk for developing muscle cramps, include:

Electrolyte depletion
Exercising in extreme heat

There are also multiple conditions that may cause lower leg muscle cramps, including diabetes, thyroid or liver disease, fibromyalgia, and nerve or blood vessel disorders. Pregnancy is another common cause of muscle cramps in the lower leg.

Lastly, some medications, like statins (cholesterol-lowering medications), may cause muscle cramps.

A medical history and physical examination, which may reveal a tender muscle or palpable knot, is generally sufficient to diagnose muscle cramps. However, if an underlying condition is suspected as a potential culprit behind the cramps, your doctor may order various blood and/or imaging tests.

Treatment for leg cramps often entails gentle stretching and massage, hydration, and applying heat. Sometimes, oral magnesium and/or calcium are recommended. Treating any underlying condition is also key to easing your muscle cramps.
Stress Fracture

A stress fracture, which refers to a tiny break in a bone, is a common occurrence in the lower leg.

The hallmark symptom of a stress fracture is localized sharp pain with activity that diminishes with rest.

Stress fractures are overuse injuries.4 Basically, the muscles surrounding bone become so fatigued from overuse that they eventually transfer the stress onto the bone, leading to a tiny break.

Stress fractures of the lower leg are most commonly seen in sports that place repetitive stress on the leg, such as running and jumping sports (e.g., gymnastics, basketball, and tennis).

An X-ray is usually enough to diagnose a stress fracture in the lower leg. Sometimes, though, the fracture cannot be visualized well on an X-ray or will not show up on one for several weeks. In these cases, your doctor may order a computed tomography (CT) scan or and MRI.

The main treatment for stress fractures is rest, usually for six to eight weeks. In addition, ice and medication, such as Tylenol (acetaminophen) or a low potency opioid, like Norco (hydrocodone/paracetamol), are used to control the acute pain of a stress fracture.
Deep Vein Thrombosis (DVT)

A serious and potentially life-threatening cause of leg pain is known as a deep vein thrombosis (DVT)—a clot in a leg vein that can break off and travel to the lungs.

In addition to cramping calf pain, other symptoms of a DVT in the lower leg include swelling, warmth, and/or redness of the calf.

A deep vein blood clot (called a thrombus) may occur as a result of an injury to the vein wall, such as from trauma or surgery, or from an underlying health condition that makes the blood more likely to clot, such as cancer or pregnancy.

Immobility, prolonged hospitalization, and obesity, all of which impair venous blood from flowing properly, also increase a person's risk for developing a DVT.

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

Treatment of a DVT entails taking an anticoagulant (blood-thinning medication) to prevent the current clot from getting bigger or from new clots forming.
Chronic Venous Insufficiency

The veins of the legs are vessels that return blood back to the heart using valves that help direct blood flow and control pressure. If the valves are not working properly, however, blood can flow backward into the veins and collect in the legs. Over time, this collection of blood can lead to increased venous pressure—a condition called chronic venous insufficiency.

Some signs and symptoms of chronic venous insufficiency include:

An aching or cramping leg pain
Lower leg and ankle swelling
Itchy, dry and/or tannish-colored skin
Presence of poorly healed wounds (called venous ulcers), especially along the inner ankle
Presence of varicose veins

Any factor or health condition that increases the pressure in the veins (enough to damage the valves and impair blood flow) can cause chronic venous insufficiency. For example, prolonged standing, obesity, and pregnancy can place additional weight and pressure on the veins in the leg, ultimately causing valve damage.

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

Diagnosis of chronic venous insufficiency involves a medical history, physical examination, and a venous duplex ultrasound.

Treatment of venous insufficiency entails leg elevation and compression stockings.6

 Peripheral Artery Disease (PAD)

With peripheral artery disease (PAD), blood flow to the leg is compromised because of narrowing of one or more leg arteries.

PAD is associated with a cramp-like pain in the calf, thigh, or buttock that is brought on with activity and relieved with rest.

In addition to cramping pain, PAD can lead to a cool and often pale limb that has an increased sensitivity to pain. Other signs of peripheral arterial disease include wounds that do not heal, toenail changes, shiny skin, and a loss of hair near the area of the leg that is affected.

The narrowing of an artery occurs as a result of fatty deposit buildup (called atherosclerosis) within the artery's walls.

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

Cigarette smoking
History of high cholesterol, high blood pressure, and/or diabetes
Older age (70 years or older)
Sedentary lifestyle
Known atherosclerosis at other sites (e.g., coronary artery disease or carotid artery disease)

If your doctor suspects PAD, he will first perform a physical examination in which he will inspect your legs and examine your pulse. To confirm a diagnosis of PAD, your doctor will perform a test called the ankle-brachial index (ABI), which 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 is multifactorial and involves lifestyle changes like stopping smoking, starting a daily walking program, and taking medication to thin your blood7 like aspirin or Plavix (clopidogrel). It also involves getting your underlying medical conditions, like diabetes, high blood pressure, and high cholesterol, under control with medication.

In more severe cases, angioplasty (when the blockage within an artery is opened using an inflated balloon) followed by stenting (when a tube is placed in the artery to keep it open) may be performed. Bypass surgery (when a graft is used to re-route blood flow from a blocked artery) may also be considered. Lumbosacral Radiculopathy

Lumbosacral radiculopathy (often called sciatica) refers to compression or irritation of one or more of the nerves that travels from your lower spine to your leg.

Lumbosacral radiculopathy causes an electric or shock-like pain in the lower back, buttocks, and/or down the leg. Numbness and tingling or burning sensations, as well as weakness in the leg, may also occur.

Lumbosacral radiculopathy may be caused by a herniated spinal disc or irritation from a tight muscle, such as seen with piriformis syndrome. Spinal stenosis—where the area around a person's spinal cord is narrowed—may also lead to nerve compression in the lower spine.

Less commonly, an infection or tumor may be the culprit behind lumbosacral radiculopathy.

In addition to a medical history and physical examination, your doctor may order imaging tests (e.g., an MRI, a CT scan) to confirm the diagnosis or access the underlying "why" behind the radiculopathy (e.g., a herniated disc versus spinal stenosis).

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

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 is generally reserved for people with persistent, disabling symptoms or those with cauda equina syndrome—a rare but very serious lumbar/sacral nerve condition that causes bladder, bowel, and/or sexual dysfunction.
A Word From Verywell

There are numerous potential causes for lower leg pain ranging from benign, mild muscle strains and cramps to more serious conditions, like blocked blood vessels. In the end, while knowledge is a powerful tool, be sure to get your lower leg pain evaluated by a doctor. You deserve to get started on your journey to recovery as soon as possible.

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