Common Causes of Lower Leg Pain

Experiencing lower leg pain can be a frustrating situation, as you struggle with determining the culprit behind your pain, in addition to the discomfort itself. Perhaps your pain is worsened with physical activity or changes in footwear. Or your pain may not be related to movement or activity but instead seems linked to a blood vessel or nerve problem.

Here are some of the more common causes of lower leg pain. Remember, though, it's best to not self-diagnose, especially if your leg pain is severe, sudden, or accompanied by swelling. See a healthcare provider for a proper diagnosis, so you can undergo prompt treatment and get back to feeling well. 

1
Muscle Strain

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A strain is a common cause of leg pain and results from increased activity that leads to overstretching of a muscle. While muscle strains usually cause mild soreness, a person may also experience cramping, weakness, and swelling.  

More sudden or severe injuries can cause a muscle tear which is significantly more painful. The gastrocnemius muscle of the calf is a common area for strains and tears.

Treatment of a muscle strain 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). Often, physical therapy can help a person ease back into their exercise regimen after a muscle strain.

Finally, stretching prior to exercise may help decrease the chance of muscle injury in the future.

 

2
Exercise-Related Injuries

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Shin splints, also known as medial tibial stress syndrome, is a common exercise-related injury. Shin splints often affect runners and those involved in sprinting or jumping sports. The pain is felt along the inside (medial) and back (posterior) part of the tibia bone where the calf muscles attach to the bone. Shin splints may be aggravated or triggered by foot conditions such as overpronation or high-arched feet.

The good news is that simple measures can be used to treat shin splints. These measures include:

  • Stopping the activity (often for weeks) that led to the shin splints; try substituting the activity with a more gentle exercise like swimming.
  • Icing the area for 20 minutes several times a day; be sure to place the ice on a towel or use a cold pack so there is no direct contact of 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.

A stress fracture of the tibia bone is another condition seen in running and jumping sports like gymnastics or basketball and, like shin splints, causes leg pain with activity. The main treatment for stress fractures, which are diagnosed with an x-ray, is rest, usually for six to eight weeks. 

A less common cause of exercise-related leg pain is exercise-induced compartment syndrome, also known as chronic compartment syndrome. This condition is often associated with people who engage in repetitive exercises like running or biking, and it causes intense leg pain, cramping, and a tight feeling in the leg muscles with activity. Sometimes numbness and/or a bulging out of the muscle can be seen. 

Treatment for exercise-induced compartment syndrome often entails avoiding the sport that led to the pain, but may also include physical therapy, switching surfaces (for example, running on track versus concrete), orthotics, and/or taking anti-inflammatory medications like NSAIDs.

 

3
Tendonitis

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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. Abnormalities in foot structure such as flat feet or high arches can trigger tendonitis.

Tendonitis causes pain that increases with activity or stretching of the affected tendon. Other symptoms may including swelling that worsens with activity as the day progresses and/or thickening of the tendon. 

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

Treatment of tendonitis entails the  R.I.C.E. protocol which is rest, ice, compression, and elevation. Anti-inflammatory medications, physical therapy, and/or orthotics are also often helpful. 

It's important to note that if you experience a sudden pain and/or "pop" at the back of your calf or heel, you have torn or ruptured your Achilles tendon. If this occurs, apply ice, elevate your leg, and see your doctor right away. 

4
Vein Problems

Varicose Vien on leg.
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The veins of the legs return blood back to the heart. When vein problems occur, leg swelling (edema) and sometimes pain or tenderness may occur. One common vein problem is venous insufficiency, which can lead to varicose veins, recurrent leg swelling, and skin changes such as a brown discoloration near the ankles. Treatment entails leg elevation and compression stockings. 

A serious and potentially life-threatening cause of leg pain is known as Deep Vein Thrombosis (DVT). A DVT is a clot in a leg vein that can break off and travel to the lungs. Symptoms of a DVT in the lower leg often include swelling, warmth, and/or redness of the calf.

A doctor can confirm the diagnosis with an ultrasound and usually prescribes a blood-thinning medication to prevent the current clot from getting bigger or from new clots forming. 

5
Peripheral Artery Disease (PAD)

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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 leg pain with exercise that is relieved by rest within ten minutes. While vein problems often cause a redness or warmth in the leg, PAD can lead to a cold, and often pale limb that has an increased sensitivity to pain.

Other signs of peripheral arterial disease include wounds that do not heal, shiny skin, and a loss of hair near the area of the leg that is affected. Factors that increase a person's chance of developing PAD are a history of smoking, ​heart disease, and diabetes. 

Treatment involves lifestyle changes like stopping smoking, exercise, and taking a medication to lower cholesterol levels (called a statin). Antiplatelet therapy like aspirin or Plavix (clopidogrel) is also indicated. 

6
Pregnancy-Related Leg Cramps

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Foot and leg problems are a common problem for pregnant women, especially in the third trimester. Sore legs and feet are often due to the increase in weight plus hormonal changes that cause the foot's arch to relax and compress down a little more. This causes a tendency toward flat feet and can also cause the leg muscles to work a little harder at maintaining foot stability, resulting in sore leg muscles.

Furthermore, painful leg cramps in pregnancy may be caused by blood volume changes or from sciatic nerve compression by the expanding uterus.

Treatment for leg cramps in pregnancy is still unclear. Sometimes, oral magnesium and/or calcium are recommended but the science to back up their use is scant. Other therapies that may be helpful include massage, stretching, and applying heat.

7
Spine Problems

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Compression of the leg nerves as they exit the spine may cause shooting pain that can extend all the way down to the foot. The pain typically starts at the buttock and is felt on the side and back of the leg. Often called sciatica, this type of pain may be caused by a herniated spinal disc or irritation from a tight muscle, such as seen with piriformis syndrome.

Nerve compression originating in the back may also cause numbness and tingling or burning sensations, as well as weakness in the leg. In serious cases, cauda equina syndrome may develop in which a person loses bladder and/or bowel function. This is serious and requires medical attention right away. 

Another spine problem that may lead to nerve compression in the lower back is spinal stenosis.

In this medical condition, the area around a person's spinal cord is narrowed causing pain that spreads to both legs, as well as numbness and weakness in the legs.

While pain begins with movement, it's eased when a person bends over, especially when sitting. Treatment entails physical therapy, along with anti-inflammatory medications like NSAIDs and/or steroid injections into the lower spine.

 

8
Underlying Health Conditions

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It's important to remember that pain in a person's leg may be the result of an underlying health problem. For example, people with fibromyalgia frequently experience restless leg syndrome and painful lower leg cramps. Leg pain can also be linked to autoimmune diseases like rheumatoid arthritis or diseases that affect the nervous system like multiple sclerosis (affects the central nervous system) and diabetes (affects the peripheral nervous system). 

Finally, certain medications like diuretics ("water pills") or statins (drugs used to lower "bad" cholesterol levels) can cause lower leg cramps. Check with your healthcare provider if you suspect your medication may be causing leg pain. 

A Word From Verywell

There are numerous potential causes for lower leg pain ranging from benign, mild muscle strains 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.

Sources:

American Academy of Orthopaedic Surgeons. (n.d.). Knee & Lower Leg. 

American Academy of Orthopaedic Surgeons. (July 2015). Sprains, Strains, and Other Soft-Tissue Injuries.

Hennion DR, Siano KA. Diagnosis and treatment of peripheral arterial disease. Am Fam Physician. 2013 Sep 1;88(5):306-10.

Trayes KP, Pickle S, Tully AS. Edema: Diagnosis and Management. Am Fam Physician. 2013 Jul 15;88(2):102-10,

Zhou K, West HM, Zhang J, Xu L, Li W. Interventions for leg cramps in pregnancy. Cochrane Database Syst Rev. 2015 Aug 11;(8):CD010655.

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