What is calf pain?
Calf pain is a common occurrence, often from a mild injury such as a cramp or muscle strain. Injuries to the calf can impact walking, running, and other movements. Symptoms may include a dull or sharp pain, tightness, or reduced range of motion. If calf pain is not treated properly, the symptoms can worsen, recovery can be prolonged and it can become a recurrent problem.[1]
The calf is made up of two muscles: gastrocnemius and soleus. Gastrocnemius generates a lot of power and propulsion during movement, whereas soleus assists more with endurance and balance.
The tendons of these muscles meet, forming the Achilles tendon which attaches to the heel. Both calf muscles help point the toes, called plantarflexion.
What are the symptoms of calf pain?
Common symptoms of calf pain include:
-
A dull, sharp, or aching pain
-
Stiffness
-
Tightness
-
Pain with plantarflexion
-
Tenderness when the muscles are stretched
-
Pain with specific movements, such as running or jumping.
What causes calf pain?
There are multiple different causes of calf pain. The calf muscles have an important role in locomotion and movement, and therefore can be injured easily.
Common causes of calf pain may include:
1. Muscle cramps
A muscle cramp is a painful contraction of a muscle. The length of the muscle cramp can vary, from a few seconds to longer. Calf cramps can be common, generally when the muscle is fatigued or under-resourced. They usually pass after a short period of time, however they can also recur. However, cramps can also be caused by medical conditions. If the cramps are persistent or related to a medical condition, a doctor should be consulted.
2. Calf strain
A calf strain or tear can occur when a muscle contracts suddenly, particularly under a great load, when the muscle is fatigued, or with improper use of the muscle. There are different types:
Grade 1: A mild calf strain will usually heal relatively rapidly.
Grade 2: A partial calf tear, often results in significant pain and some loss of function.
Grade 3: A complete calf tear, is a significant injury that requires a prolonged period of recovery or surgery.
3. Achilles tendinopathy
Achilles tendinopathy is an overuse injury.2 Tendinopathies often develop gradually over a period of time, when the muscle is repetitively overloaded and stressed without adequate time for rest and recovery. Common symptoms may include focal tenderness, pain with running or jumping, and stiffness. Physiotherapists or sports doctors are usually involved in the management and treatment of Achilles tendinopathy.
4. Sciatica
Sciatica is a term that describes pain or symptoms in the sciatic nerve, a large nerve running from the buttocks to the foot that controls the muscles in the leg. When this nerve is irritated or compressed, it can cause shooting or ‘electric’ type symptoms in the leg, calf, and foot. The symptoms usually occur on one side of the body, but can occur on both.
5. Contusion
A contusion, commonly known as a bruise, results from a direct impact to a soft tissue area. When large forces come in contact with soft tissue, it can disturb the capillaries and cause discolouration. Calf contusions are common injuries in contact sports, such as rugby and AFL football.
Contusions often heal on their own. However, unexplained or bruises without cause should be examined by a doctor.
6. Peripheral neuropathy
Peripheral neuropathy is a condition that describes a type of nerve damage that affects the peripheral parts of the body, particularly the legs and feet. There are different factors that contribute to peripheral neuropathy, however it is a common complication of diabetes. Symptoms often develop gradually, and can include tingling, impaired sensation, reduced balance, or muscle weakness. Peripheral neuropathy is usually diagnosed and managed by a doctor or specialist.
7. DVT (Deep vein thrombosis)
A blood clot can form in the deep veins in the leg, known as a DVT (deep vein thrombosis). It is a medical emergency as the blood clot can travel to the lungs or brain, and have serious consequences. Blood clots form for a number of reasons, including certain medications, prolonged bed rest, or other medical factors. Common symptoms include swelling, discolouration, calf tenderness or pain, and heat or warmth in the area.[3] It is therefore important to consult a doctor if there are any concerns.
8. Leg compartment syndrome
Acute compartment syndrome occurs when pressure builds up in a muscle compartment, typically from blood or fluid. Compartment syndrome can be caused by trauma or injury to the area. It is a medical emergency as the pressure can cause nerve damage and tissue death as the blood supply can get cut off. It requires immediate medical attention and possibly surgery.
Other causes
Other causes of calf pain can include pathologies such as a Baker’s cyst, infection, fracture, tumour, and more. It is important to consult a doctor to rule out any serious medical conditions before any treatment starts.
When to see a doctor
Calf pain can be a red flag sign, indicating a serious underlying medical condition, such as a DVT or fracture.
A doctor should be consulted immediately if there are any symptoms including:
-
Skin discolouration or redness
-
Severe, persistent, or unbearable pain
-
Bleeding
-
Swelling
-
Night pain
-
Being unable to weight bear
-
Shortness of breath
-
Loss of bladder or bowel control
-
Sudden weakness or numbness.
How is calf pain treated?
The management and treatment of calf pain may vary from person to person. There are many causes of calf pain, therefore different treatments will work better than others depending on the cause.
Common treatment may include:
-
RICE principles (Rest, Ice, Compression, Elevation) - The RICE principle is a standard treatment practice used to manage soft tissue injuries in the early stages. It can help alleviate symptoms and encourage the healing process.
-
Pain relief - A doctor may recommend over-the-counter medications or prescription medications for pain relief, depending on the cause of the symptoms.
-
Rest - Relative rest is important to allow the tissues to repair and recover.
-
Physiotherapy - Physiotherapy can be beneficial to help restore movement and strength, particularly after an overuse injury.
-
Surgery - Surgery is usually only considered for severe injuries or if there is an underlying medical condition. A doctor may recommend a review with a surgeon to discuss the options.
If the calf pain is caused by a serious condition such as DVT or compartment syndrome, it will require immediate medical attention and treatment.
Prevention of Calf Pain
Whilst some causes of calf pain may not be preventable, there are some key factors that can reduce the risk of developing calf pain.
This may include:
-
Warm-up - Completing a warm-up before exercise, particularly before running or jumping activities, can help prepare the muscles for movement and prevent calf injuries.
-
Recovery - Allowing the calf muscles to rest and recover between activities is important to prevent overuse and overload.
-
New exercises - It is important to introduce any new exercises or activities gradually. This can help condition the muscle and prevent overload.
-
See a health professional - Health professionals such as physiotherapists can create exercise programs to target calf and overall body strength and function to help prevent future injuries.
Key messages
Calf pain is common, especially in high intensity sports or activities that involve running and jumping. In many cases, calf pain can settle with rest or basic treatments. Calf pain can also be caused by an underlying medical condition, so it’s important to be aware of any red flags and seek help from a doctor. If calf pain is not treated properly, the symptoms can worsen and recovery can be prolonged.
