Lower Leg Pain (Shin & Calf)

Injuries to the lower leg can be acute (sudden onset) or chronic (gradual onset). The most common cause of pain at the front of the lower leg is known as shin splints and refers to pain along the bone on the inside, lower part of the shin,which develops gradually over time. A calf strain is the most likely cause of sudden onset pain at the back of the leg.

On this page:

  • Sudden onset calf pain
  • Chronic calf pain
  • Shin pain

Calf Pain

Calf injuries including calf strain

Calf injuries including sudden onset or acute injuries, such as calf strain, gradual onset or chronic injuries, including compartment syndrome, as well as DVT or Deep Vein Thrombosis which should not be missed.

Calf strain

Probably the most common cause of calf pain. Symptoms include a sudden sharp pain at the back of the lower leg. Calf strains range from very mild to severe. Swelling is likely in more severe injuries. Immediate first aid of rest, ice, compression, and elevation is important followed by a full rehabilitation program, which includes stretching, strengthening, and sports specific exercises.

Cramp

Cramp is a sudden, painful involuntary contraction or spasm of the muscle and is something most hard training sports people might have experienced at some point in time. Although most episodes of cramp are not serious and resolve quickly it is possible in severe bouts damage can occur to the muscle tissue causing a longer term muscle injury. The exact causes of cramp are not precisely known but dehydration, low salt, and low carbohydrate levels are thought to be factors. Cramp can often be relieved by stretching the muscles involved, often with the help of a partner.

Acute posterior compartment syndrome

An acute compartment syndrome can occur following a direct impact to the muscle causing bleeding which is contained within the muscle sheath. Symptoms of pain, which is particularly severe or increases in severity will be experienced. If an acute compartment syndrome is suspected then medical advice should be sought as it can result in more serious long-term damage.

Lateral compartment syndrome

This is the same kind of calf injury as the above as it usually occurs after a direct impact, but it refers to an injury specifically to the outer calf muscle. The pain would be located more at the back of the leg and the outside of the calf may be swollen and tender.

This is calf pain which occurs gradually over time, where the patient cannot pinpoint an exact time or incident which caused the injury. It may have started out as tightness in the muscle or a niggle and become gradually worse. Or, calf pain may occur gradually during a run, then ease off following a period of rest.

Tight calf muscles

Tight lower leg muscles are a widely seen calf problem among athletes. The tight muscles can be caused by poor biomechanics, lack of stretching and wearing high heeled shoes. If the calf muscles are contracted, blood can't get to the area so easily which can cause discomfort and pain. If left untreated, this can increase the risk of suffering from a more severe and acute injury.

Posterior compartment syndrome

A deep aching pain or tightness in the back of the lower leg occurs gradually during a run but then eases off with rest. Experienced runners may find the pain comes on at the same point in a run consistently. A chronic compartment syndrome occurs when the muscle grows too big for the sheath surrounding it resulting in painful pressure. Various treatment options include rest, applying ice and massage, however, some injuries may require surgery.

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Shin Pain

Shin pain

Pain in the shin is usually of gradual onset and can be difficult to get rid of. Shin splints is the most widely used term to describe pain on the inside of the shin, but this not actually a diagnosis in itself. Here we explain the injuries which cause what most people describe as shin splints as well as treatment, rehabilitation, and prevention.

Pain on the inside of the thin:

Shin splints

Shin splints are the most common cause of shin pain but, although the term is widely used, it is not a specific injury, more a term to describe pain of which there are a number of causes. It is used to describe general pain at the front of the lower leg, which can have several different specific causes. Medial tibial stress syndrome is the most common injury linked to shin splints. Symptoms include shin pain on the lower inside area along the bone which may feel tender to touch with swelling, lumps and bumps felt.

Stress fractures of the tibia

Tibia stress fractures have symptoms similar to medial tibial stress syndrome with long term gradual onset pain on the inside lower part of the shin. The shin may also feel tender to touch and show swelling. An Xray may not show up a stress fracture until it has started to heal so they can be difficult to diagnose. Long-term rest of a few weeks is often indicated if shin splints type pain persists.

Pain on the outside of the shin:

Anterior compartment syndrome

A compartment syndrome occurs when the muscle swells up within its surrounding sheath causing increased pressure and pain. With gradual onset or chronic shin pain on the outside of the leg the large tibialis anterior muscles increases from training and overuse. It will probably be difficult to lift up the foot. When the athlete exercises, it fills with blood and expands causing pain. With rest the pain eases only to return again when normal training resumes. Treatment may involve longer-term rest, biomechanical analysis, taping, or in some cases surgery is required to release the sheath allowing the muscle to expand.

Acute anterior compartment syndrome

As well as appearing gradually through overuse, a compartment syndrome can be caused by a direct impact or contusion. Bleeding of the muscle within the sheath occurs causing increased pressure and pain which can be severe. If pain becomes progressively worse and an acute compartment syndrome is suspected then seek medical attention immediately as long term damage can result.

Tibia fractures and fibula fractures can occur after an acute trauma or impact. The lower leg is a common area for fractures and can often be broken in contact sports like rugby. A broken leg can take a while to heal, depending on where the fracture is and how clean the break is.

Read more on shin pain.