Lower Leg Pain Overview

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.

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.

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.

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.

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. 

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.