Lower Leg Pain Overview

As we age, the bones in our legs can get thinner and muscle mass decreases. While some changes with aging are totally normal, too much change can result in leg pain and discomfort during even simple tasks, such as walking and climbing stairs. Trying to find an effective treatment for your lower leg pain can be frustrating since it can be caused by a variety of underlying issues. In this guide, you will learn about its causes, symptoms, and diagnostic procedures so you can start focusing on treatment and recovery.

Understanding Pain in the Lower Leg

Injury, illness, and aging can affect the structures in the leg, causing pain, discomfort, and inflammation. There is often more than one root cause of aching pain in the lower legs.

Location of Lower Leg Pain

The exact location of pain in the lower leg can vary depending on the underlying issue. Lower leg pain may be a sign of a potentially life-threatening condition, or it may be easily treatable at home. It’s important to understand the correlation between pain locations and causes of pain.

• Lower Back Leg Pain

  Pain in the back of your lower leg may be a calf strain, which often occurs because of overstretched calf muscles or during a sudden pushing off movement. Lower back leg pain resulting from a calf muscle tear may range from mild to very severe. A grade 1 calf injury does not require professional treatment, but grades 2 and 3 calf injuries do.

• Medial Lower Leg Pain

  Pain located on the inside lower legs, on the other hand, is located in the deep muscles shin like the posterior tibialis (sometimes termed posterior shin splints). Typically, this pain occurs gradually with changes in activity level and can be difficult to treat. Most cases of medial lower leg pain are caused by tendon inflammation, bone stress, compartment syndrome or nerve entrapment.

• Anterior Lower Leg Pain

  Pain in the front of the shins is common with high impact activity or sudden changes in activity level. With runners and other athletes, you will most often hear pain in this area referred to as shin splints- caused by strain and inflammation of the tibialis anterior. 

• Generalized Lower Leg Pain

  All of the above mentioned pain areas refer to specific muscle groups or connective tissue affected. However, pain that is harder to pinpoint can also be present in the lower leg. For example, nerve damage from the lower back can lead to symptoms, most often a sharper pain,  in specific neural distributions. Additionally, damage within local blood vessels can also be a cause for generalized pain and aching.

Causes of Pain in the Lower Leg

While lower leg pain is common, it should not be ignored. Understanding what causes pain in lower legs is crucial to choosing a treatment plan. Pain in the lower legs is most commonly brought on by issues with bones, muscles, veins, clots, or nerves.

Pain in Lower Leg Bone

• Sprained Joint or Broken Bones

  Traumatic leg injuries are the most obvious cause of pain in lower leg bones. If your lower leg pain keeps you from standing or walking, you are likely suffering from an ankle sprain or a broken bone of the tibia or fibula. The first symptom after an ankle sprain is typically pain in lower legs and feet. In the case of a broken bone, whether caused by a fall, repetitive impact (as with a stress fracture), or underlying osteoporosis, pain in the lower leg must be taken seriously. Stop any activity that causes pain, and call your doctor immediately.

Lower Leg Muscle Pain

• Muscle Cramp

  A muscle cramp is a painful and intense tightening or contraction of a muscle. In the lower leg, it is most often in the calf muscles, which usually strikes while sleeping. Cramps happen when the muscles are dehydrated or tired. Cramps are rarely serious, but you should be concerned if you experience leg cramps regularly.

• Tendonitis

  Lower leg (calf) pain may be a warning sign that you have an inflamed Achilles tendon. Tendonitis is a common injury that makes the tendon tear, stretch, or swell. Lower leg tendon pain is often caused by overuse of the calf muscle during physical activity. You can also experience tendinitis in other surrounding shin muscles too, such as the tibialis anterior and tibialis posterior.

• Shin Splints

  Also known as medial tibial stress syndrome, shin splints are another potential cause of extreme lower leg pain. Tibial stress syndrome refers to pain and inflammation of the tendons and muscles that attach to the tibia (shinbone), primarily the tibialis anterior. This type of injury occurs due to constant overuse from running or other high-impact exercises. Those with poor body alignment and muscular imbalances are more likely to develop shin splints. If symptoms are not well managed it can lead to the very serious complication of compartment syndrome, where muscle “compartments” within the shin become inflamed with no way to relieve pressure- resulting in nerve damage.

Pain in Both Lower Legs

• Varicose Veins

  Those dark, twisted veins are one of the major causes of pain in lower legs. Varicose veins are caused by weak vein walls and valves and come with a dull, aching pain in both lower legs.

• Peripheral Artery Disease

  This disease is characterized by narrowing of the arteries in the legs or arms. As it progresses, it can limit blood flow and oxygen perfusion to muscles in the legs. Ultimately, you may experience pain and cramping in the legs when you work the muscles too hard and your arteries can’t keep up the necessary demand, known as claudication. Some research correlates this issue to high cholesterol, caused by atherosclerosis. 

• Blood Clot

  Sometimes, deep vein thrombosis (DVT) is what causes lower leg pain. It is most likely to happen if you are smoking, inactive for long periods, or taking certain medications. When left untreated, the deep-vein blood clot often detaches into the bloodstream and reaches an artery in the lungs, or even heart. This is a serious condition known as a pulmonary embolism.

Painful Lower Legs: Nerves

• Sciatica and Stenosis

  Arthritis of the spine is a common cause of spinal stenosis or a narrowed spinal canal. Sometimes, a herniated disc places too much pressure on nerve roots and results in symptoms of back pain and sciatica, which include fatigue, weakness, numbness, tingling, and painful lower legs (back and/or side of the leg) when sitting or standing. Stenosis can also affect the femoral nerve and lead to lower leg pain in a distribution on the front of the lower leg. 

• Peripheral Neuropathy

  Damage of peripheral nerves in the limbs can result in generalized aching and pain. This condition is most common diabetes and use of certain medications. 

• Local Nerve Injury

  Outside of more centralized nerve damage, more localized damage can also occur to nerves in the lower leg. This most often occurs simultaneously with another injury, with local inflammation causing nerve compression or entrapment, resulting in lower leg pain. 

Symptoms of Severe Pain in Lower Leg

Associated symptoms vary widely depending on the cause of chronic lower leg pain. Here are some common descriptions of the pain and associated symptoms:

• Tightness and lower leg pain at night
• Weakness in the lower leg pain
• Difficulty bearing weight or walking
• Dull, aching, or sharp pain in knee and lower leg
• Mild to severe ankle and lower leg pain
• Pain in feet and lower legs
• Swelling
• Mild to moderate bruising

Diagnosing Chronic Lower Leg Pain

A self-diagnosis is not sufficient for lower leg pain that is sudden, severe, or accompanied by swelling. Chronic lower leg pain is most often part of a larger collection of symptoms and will need to be evaluated as a multifaceted issue. Visit your doctor for an accurate diagnosis, so you can begin proper treatment as soon as possible and reduce your risk of long standing issues. While an in-depth history and physical exam is most important for diagnosis, here are some common diagnostic tests you may encounter:

• X-Ray

  Your doctor will begin evaluating your lower leg pain by performing a thorough physical examination. A series of X-rays may be required if your doctor suspects a broken bone or fracture is present. In addition, an X-ray may help identify fluid or calcifications in the knee or ankle joint.

• Ankle-Brachial Index

  An ankle-brachial index, or ABI, helps assess the arterial blood flow in the lower legs. This type of examination compares the blood pressure in the legs to the blood pressure in the arms. This can help diagnose circulatory issues and blood clots. 

• Arteriogram

  Your doctor may conduct an arteriogram to gain more information about the arteries. This test studies the arterial supply to the legs by injecting contrast dye into the arteries.

• MRI

  An MRI may be used to examine the joints, bones, and soft tissues to determine the cause of pain inside lower legs. Your doctor may also perform an MRI angiography to evaluate blood vessels in your body.

• CT Scan

  Healthcare providers use CT scans in a variety of situations, such as to study the joint and bone anatomy or find fractures. A CT angiography can take the place of an arteriography in certain situations.

• Ultrasound

  An ultrasound can help diagnose deep vein thrombosis or muscle strain. This test is also used to diagnose joint inflammation and swelling.

Dealing with Severe Lower Leg Pain

Whether you love playing sports or going on morning jogs, you do not want to be stuck inside your house with intermittent or constant lower leg pain. Properly dealing with moderate to severe lower leg pain will help you enjoy life. Depending on the cause, treatment may vary from physical therapy and exercise to anti-inflammatory medication (like ibuprofen) and surgery. By sticking to your doctor’s treatment plan, you will be able to stand and walk comfortably again. Be patient as you slowly increase your strength, and pay attention to your body’s warning signs to prevent re-injury.

Sources:

https://www.webmd.boots.com/pain-management/guide/lower-leg-pain-causes-and-treatments

http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain

https://www.emedicinehealth.com/leg_pain/article_em.htm#leg_pain_quick_overview

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