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Lower Leg Pain: Causes, Symptoms & Common Doctor Questions

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Do you experience lower leg pain at night? What about lower back and leg pain? Learn about what's causing your lower leg pain symptoms and relief options.

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Lower leg pain symptoms

We need our legs for a lot of the activities of daily living and, for the most part, we take them for granted. It is not until you are having lower leg pain that you realize just how important your calves are for ambulation.

The lower leg consists of muscles, bones, tendons, ligaments, joints, blood vessels, and nerves. Damage or irritation to any of these structures can lead to lower leg pain. As pain is the body's way of telling you something is wrong and it needs to heal, it is wise to pay attention to this pain rather than "fight through it."

Common characteristics of lower leg pain

Lower leg pain may be associated with these common symptoms:

Lower leg pain causes

For the most part, lower leg pain is due to musculoskeletal injury any sort of strain, sprain, tear or other damage you may incur from sports or everyday living. Such injuries are inevitable as we use our legs any time we need to get around: to score a soccer goal, or to carry that heavy box down the street. While many of these wear-and-tear injuries are quite minor, other causes of lower leg pain can require urgent treatment.

Musculoskeletal causes

Causes related to the musculoskeletal system may include the following.

  • Strains and sprains: Overuse or acute injury can cause tears of lower leg muscles, tendons or ligaments. This will cause pain with use of the lower legs.
  • Joint damage: Years of wear-and-tear or acute injury to the joints of the lower leg may cause inflammation of the joints called arthritis.
  • Fracture: Acute trauma to the lower leg can cause the tibia, fibula, or other bones to break.
  • Overuse: If you've been hitting the stair-climber too hard or suddenly increased the amount of running you do, your muscles may be sore, causing mild to moderate pain with use.

Vascular causes

Causes related to the vascular system may include the following.

  • Clot: Certain people are predisposed to forming blood clots in the lower legs (deep vein thrombosis or DVT), especially when they are stationary for long periods of time. These clots may cause pain and swelling of the affected leg.
  • Vascular disease: If you experience pain or cramping with exercise or at night in your lower legs, you may have vascular disease. This is seen most commonly in smokers and diabetics.

Infectious causes

Infection-related causes of lower leg pain may include the following.

  • Tissue infection: Infection of the skin or soft tissues of the lower leg can cause localized pain, usually irritated by touch.
  • Joint infection: Infections of the knee, ankle, or toe joints can cause pain in the lower leg which is usually aggravated by movement.

Autoimmune causes

Certain autoimmune diseases attack the joints of the lower legs, such as multiple sclerosis, leading to damage, inflammation, and pain.

Nervous causes

A peripheral nerve injury, such as oneimpacting the nerves that innervate the lower leg, can cause pain.

Metabolic causes

Metabolic-related causes may include the following.

  • Electrolyte imbalance: Dehydration and resultant electrolyte imbalance may cause lower leg cramping and pain, especially if you are low in potassium.
  • Hereditary: Some rare hereditary disorders can cause painful cramping of the muscles.

This list does not constitute medical advice and may not accurately represent what you have.

Repetitive strain injury of the calf

Repetitive strain injury of the calf is caused by consistent repetitive use.

Rarity: Uncommon

Top Symptoms: lower leg numbness, calf pain from overuse

Symptoms that always occur with repetitive strain injury of the calf: calf pain from overuse

Symptoms that never occur with repetitive strain injury of the calf: recent calf injury, severe calf pain

Urgency: Self-treatment

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Tibial stress fracture

A tibial stress fracture is a small crack in the shinbone (tibia). These fractures are most often a result of overuse and are commonly seen with an increase in activity. Usually stress fractures of the shinbone occur in the lower third of the bone.

You should visit a doctor who can confirm the diagnosis, sometimes a MRI scan is needed. You should rest for around 8 weeks, and avoid any activities that put repeated force on the feet, such as running. You may also find it helpful to do exercises to maintain strength and flexibility in the lower leg, such as light calf raises as long as they do not cause any pain.

Spinal stenosis

The spine, or backbone, protects the spinal cord and allows people to stand and bend. Spinal stenosis causes narrowing in the spine. The narrowing puts pressure on nerves and the spinal cord and can cause pain.

Next steps including visiting a primary care physician. For this condition, a physician might suggest further investigation including imaging of the spine. Treatments may include medications, physical therapy, or braces. For severe cases, surgery is sometimes recommended.

Shin splints (medial tibial stress syndrome)

Shin splints is when there is pain in the front part of the lower leg. The pain is from the swelling of the muscles, tendons, and bone tissue around your shin.

You can safely treat this condition on your own with rest and ice. Wearing proper footwear and modifying your exercise routine can help prevent shin splints from recurring.

Rarity: Common

Top Symptoms: shin pain, dull, achy shin pain, pain in the inside of the shin, shin pain from overuse, irregular period

Symptoms that always occur with shin splints (medial tibial stress syndrome): shin pain

Urgency: Self-treatment

Restless legs syndrome (RLS)

Restless Legs Syndrome, also called RLS or Willis-Ekbom Disease, is a neurologic and sensory disorder. It causes uncomfortable sensations in the legs that are only relieved by walking or by moving the legs.

The cause is not in the legs but in the brain. One theory is low levels of iron in the brain.

RLS may be hereditary. It is more common in women than in men, especially in middle age. It may get more severe as the person gets older.

Symptoms may happen only a few times a week and are usually worse at night.

There will be an irresistible urge to move the legs in order to relieve the uncomfortable sensations; difficulty sleeping, with daytime exhaustion and inability to concentrate; and sometimes depression and anxiety due to the effect on quality of life.

Diagnosis is made through patient history and physical examination. Blood tests and sleep studies may be done.

Treatment involves first addressing any underlying medical condition, such as iron deficiency. In some cases, anti-seizure medications can be helpful.

Peripheral arterial disease (PAD)

Peripheral artery disease (PAD) is a chronic condition that reduces blood flow in the arteries, usually arteries that lead to the legs. This reduced blood flow happens when clumps of fat (called plaques) build up inside these arteries, causing them to narrow. Symptoms include leg numbness, foot and thigh pain, cold feet, and muscle fatigue. These symptoms often occur when walking or exercising. The risk of developing PAD is higher in those who smoke or have diabetes. High blood pressure, high cholesterol, being overweight, and not getting much exercise also can put one at higher risk.

You should consider visiting a healthcare provider in the next two weeks to discuss your symptoms. Your provider can evaluate PAD with a review of your symptoms and a physical exam. An MRI may be performed as well. Once diagnosed, treatment involves medication, surgery, or procedures to open or bypass blocked arteries. Lifestyle changes regarding diet, exercise, and smoking cessation may also help.

Rarity: Common

Top Symptoms: leg numbness, spontaneous foot pain, decreased exercise tolerance, cold feet, thigh pain

Symptoms that never occur with peripheral arterial disease (pad): calf pain from an injury, thigh pain from an injury

Urgency: Primary care doctor

Paget disease of the bone

Paget disease of bone is also called PDB, osteitis deformans, or osteodystrophica deformans. It is normal for bone cells to renew themselves throughout life, but in PDB the renewal becomes disordered. New bone cells are produced too quickly, causing the bones to become weakened and overgrown.

The cause of PDB is not known. It may be due to an inherited trait combined with certain viral infections.

Symptoms include enlargement, bowing, and abnormal curving of the bones, with pain and tenderness. The skull, pelvis, spine, and upper arms and thighs are most often affected. However, many patients have no symptoms and the condition is discovered while assessing something else.

If not treated, Paget disease of bone can lead to bone deformity; fractures; osteoarthritis; and hearing loss due to changes in the small bones within the ear.

Diagnosis is made through blood tests and an x-ray or CT scan.

There is no cure, but symptoms can be managed with medication, pain relievers, physical therapy, and sometimes surgery.

Fibular nerve injury

The fibular nerves are also known as the peroneal nerves. Fibular nerves run from the lower spine all the way down the back of the leg, ending at the heel. If the are damaged or compressed, this can result in a condition known as foot drop.

The fibular nerves can be damaged through surgery, especially hip replacement or total knee replacement; any injury to the knee or low back; or neurologic diseases such as multiple sclerosis or Parkinson's disease.

Foot drop means that the person is unable to flex the foot upward from the ankle, because the fibular nerves that control this voluntary movement have been damaged. There may also be pain, numbness and weakness in the foot, and difficulty walking.

Diagnosis is made through physical examination, nerve conduction studies, and imaging such as x-ray or MRI.

Treatment involves using orthotics, which are specially made shoes, supports, and braces for the foot; physical therapy; and sometimes surgery to decompress or otherwise help repair the nerve.

Fibromyalgia

Fibromyalgia is a set of chronic symptoms that include ongoing fatigue, diffuse tenderness to touch, musculoskeletal pain, and usually some degree of depression.

The cause is not known. When fibromyalgia appears, it is usually after a stressful physical or emotional event such as an automobile accident or a divorce. It may include a genetic component where the person experiences normal sensation as pain.

Almost 90% of fibromyalgia sufferers are women. Anyone with rheumatic disease, such as rheumatoid arthritis or lupus, may be more prone to fibromyalgia.

Poor sleep is often a symptom, along with foggy thinking, headaches, painful menstrual periods, and increased sensitivity to heat, cold, bright lights, and loud noises.

There is no standard test for fibromyalgia. The diagnosis is usually made when the above symptoms go on for three months or more with no apparent cause.

Fibromyalgia does not go away on its own but does not get worse, either.

Treatment involves easing symptoms and improving the patient's quality of life through pain medications, exercise, improved diet, and help with managing stressful situations.

Lower leg pain quiz

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Chronic idiopathic peripheral neuropathy

Peripheral neuropathy refers to the feeling of numbness, tingling, and pins-and-needles sensation in the feet. Idiopathic means the cause is not known, and chronic means the condition is ongoing without getting better or worse.

The condition is most often found in people over age 60. Idiopathic neuropathy has no known cause.

Symptoms include uncomfortable numbness and tingling in the feet; difficulty standing or walking due to pain and lack of normal sensitivity; and weakness and cramping in the muscles of the feet and ankles.

Peripheral neuropathy can greatly interfere with quality of life, so a medical provider should be seen in order to treat the symptoms and reduce the discomfort.

Diagnosis is made through physical examination; blood tests to rule out other conditions; and neurologic and muscle studies such as electromyography.

Treatment involves over-the-counter pain relievers; prescription pain relievers to manage more severe pain; physical therapy and safety measures to compensate for loss of sensation in the feet; and therapeutic footwear to help with balance and walking.

Rarity: Rare

Top Symptoms: distal numbness, muscle aches, joint stiffness, numbness on both sides of body, loss of muscle mass

Urgency: Primary care doctor

Calf strain

A strain, commonly called a "pulled muscle," is when a muscle becomes overstretched, and microscopic tears occur. A calf strain happens when one of the muscles on the back of the lower leg is pulled.

You can safely treat this condition on your own. A muscle strain can be treated with rest, ice, compression, and pain medication.

Rarity: Common

Top Symptoms: pain in one calf, moderate calf pain, calf pain, sports injury, soccer injury

Symptoms that always occur with calf strain: pain in one calf

Urgency: Self-treatment

Lower leg pain treatments and relief

Most causes of lower leg pain are just aches and pains caused by minor injuries to the muscles, tendons, and ligaments in the lower leg. These types of injuries can be managed at home quite easily. However, if you experience sudden-onset, moderate to severe pain with no obvious cause or find yourself with an acute injury so severe it is difficult to walk, you should seek medical attention promptly.

At-home treatments for lower leg pain

Several treatments can be tried at home to soothe lower leg pain. The first four methods can be remembered with the mnemonic RICE.

  • Rest: Most minor injuries will improve with time and rest as the body heals itself.
  • Ice: Cold packs can diminish inflammation of aggravated tissues, alleviating some pain.
  • Compression: A moderately tight wrap around an injured joint can help diminish inflammation.
  • Elevation: Elevating an injured ankle or lower leg can reduce swelling.
  • Stretching: Light stretching of an injured extremity helps with the healing process and prevents the muscles from getting too tight.
  • Rehydration: Drinking fluids with electrolytes can help leg pain caused by cramping when dehydrated.
  • Acetaminophen or NSAIDs: Over-the-counter pain medications like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) reduce pain and inflammation.

Medical treatments for lower leg pain

Treatments that will need to be recommended by your medical provider may include the following below. It is important to seek consultation if your lower leg pain worsens or persists.

  • Physical exam: A healthcare provider will examine the leg to help diagnose the cause of the pain.
  • Imaging: Ultrasound, CT, or MRI scans may be required to diagnose the cause of the leg pain.
  • Physical therapy: Oftentimes physical therapy is the most effective means to heal an injured extremity.
  • Pain medication: Pain medications can help reduce pain acutely.
  • Surgery: Some conditions causing lower leg pain may require surgery to repair.
  • Anticoagulation: Lower leg pain caused by clots usually requires the use of blood-thinning medications to resolve.

When lower leg pain is an emergency

Seek immediate treatment or call 911 for the following:

  • Inability or difficulty weight-bearing or walking on the affected extremity
  • Moderate to severe lower leg pain after an injury
  • Sudden-onset leg pain with no clear cause
  • Swelling of one lower leg but not the other
  • Discoloration or cool temperature in the affected leg
  • Sudden-onset difficulty breathing and chest pain associated with lower leg pain

Questions your doctor may ask about lower leg pain

  • Any fever today or during the last week?
  • Have you ever been diagnosed with diabetes?
  • Where on your lower leg are you experiencing pain?
  • What is your body mass?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

  1. Sprains, strains and other soft-tissue injuries. American Academy of Orthopaedic Surgeons: OrthoInfo. Updated July 2015. OrthoInfo Link
  2. Ebell MH. Osteoarthritis: Rapid evidence review. American Family Physician. 2018;97(8):523-6. AAFP Link
  3. Peripheral vascular disease. American Health Network. AHNI Link
  4. Understand your risk for excessive blood clotting. American Heart Association. AHA Link
  5. Mader JT, Calhoun J. Bone, Joint, and Necrotizing Soft Tissue Infections. Baron S, eds. In: Medical Microbiology. 4th ed. Galveston, TX: University of Texas Medical Branch at Galveston; 1996. NCBI Link