What is calf pain?

Calf pain is pain in the calf muscle which is at the back part of the lower leg. The calf is made up of 2 muscles called the gastrocnemius and the soleus. They meet at the Achilles tendon which attaches to the heel bone.

What are the symptoms of calf strain?

If you have a calf strain you may experience symptoms such as:

• sudden pain at the back of your leg
• your calf is stiff and weak when you walk
• you find it hard to rise up onto your toes
• swelling or bruising in the calf muscle

Calf strain is categorised into grades:

• Mild — sharp pain (during or after activity).
• Moderate — pain that means you can’t continue regular activity.
• Severe — severe pain between your Achilles tendon and the middle of the muscle.

Sometimes calf pain can be a symptom of something more serious that needs urgent medical attention.

What causes calf pain?

Common causes of calf pain are a cramp or muscle strain in the calf.

A cramp is when the muscles suddenly tightens causing pain. This might happen if you have been doing new exercises, if you are dehydrated, or if you are deficient in some dietary minerals. Cramps normally go away by themselves.

Sometimes cramps can be a symptom of an underlying medical issue. If you have regular or severe cramping that lasts longer than a few minutes you should speak with your doctor.

A calf strain is the overstretching or tearing of either of the 2 calf muscles.

Other possible causes of calf pain include:

• Achilles tendon injuries such as Achilles tendinopathy or a sudden rupture of your Achilles tendon
• sciatica — when you have problems with the sciatic nerve which controls your lower leg
• a bruise due to injury
• diabetic peripheral neuropathy — when you have nerve damage that affects your feet, legs, arms and hand
• deep vein thrombosis (DVT) — when a blood clot forms in the deep veins most commonly in the leg (this is a medical emergency, see your doctor immediately if you think you might have DVT)
• compartment syndrome — a serious condition caused by trauma to the muscle

When should I see my doctor?

Seek medical attention straight away if you have the symptoms of DVT and you have recently been sitting for a long time, such as on a flight. These include if:

• your calf is swollen
• your leg is painful
• the skin of the calf is red
• your calf feels tender

Make an appointment with your doctor if

• you have fluid retention
• your calf is unusually cool or pale, or alternately red, warm and tender
• your leg is weak, tingly or numb
• both legs are swollen and you have breathing problems
• your calf pain:
  • involves regular or severe leg cramps
  • is associated with varicose veins
  • get worse during or after walking
  • gets worse or doesn't improve after a couple of days of being treated at home

How is calf pain treated?

If you have a muscle cramp, gently stretch or massage the muscle. A cramp will usually pass on its own. If you are getting regular cramps or they last longer than a few minutes make an appointment to see your doctor.

If you have a calf strain or Achilles tendonitis, first use the ‘RICER’ method of treatment:

• Rest the area.
• Ice the area for 20 minutes, using a covered icepack or bag of frozen peas.
• Compress the area with a bandage (but if the pain gets worse, loosen the bandage).
• Elevate the lower leg by sitting or lying down (for example with pillows), so it is above the level of the heart.
• Referral to a sports medicine professional.

The No HARM method should also be followed to lower any bleeding or swelling:

• no heat
• no alcohol
• no running or activity
• no massage

Once the pain goes down you can start gently stretching and strengthening the muscle, for example by doing heel raises and calf stretches.

Don't return to full physical activity until you can move your ankle and knee properly, the pain and tenderness have gone and the strength has fully returned to your calf. Depending on the grade of calf sprain, speak with a medical professional before returning to your regular activity. Typically, you will be able to return to your usual physical activity after:

• 10 to 12 days rest with mild calf strain
• 16 to 21 days rest with moderate calf strain
• up to 6 months rest, if you have surgery, for example, for Achilles tendon injury

Can calf pain be prevented?

You can prevent calf pain and injuries by:

• always stretching before and after you exercise to repair and strengthen the calf
• not over-exercising and building up gradually if you are starting something new
• wearing correct protective equipment and shoes
• drinking plenty of water during and after physical activity

Some people take magnesium supplements ​to prevent cramps, although the evidence is not conclusive. If you have diabetes, keep your blood sugar levels under control to prevent diabetic neuropathy.

Resources and support

If you have calf pain that is ongoing or you have a calf injury that does not resolve by itself, speak with your doctor.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Sports Medicine Australia offers advice on risks, prevention and rehabilitation of calf strains.

Diabetes Australia has information on prevention of diabetic neuropathy.