Calf Pain

Whether when walking, running, climbing stairs or at rest - calf pain can occur in a wide variety of situations and can be very uncomfortable for those affected. In most cases, an overload or incorrect posture is the trigger for the pain, which can sometimes become so severe that sporting activity or even normal walking are no longer unrestricted.

In addition, calf pain can also be triggered by a serious illness such as thrombosis or circulatory disorders such as peripheral arterial occlusive disease (" intermittent claudication "). Accordingly, in the case of sudden, severe pain, as well as persistent or frequently recurring complaints, a doctor should be consulted to clarify the cause precisely.

definition

Pain in the calves occurs frequently and is usually described as boring and / or pulling, and in most cases the symptoms are aggravated by exertion such as exercise or climbing stairs. Calf pain can also show itself at rest, the best example here are calf cramps that suddenly occur at night or after long periods of rest. The symptoms can basically persist, but they can also appear again and again in short attacks; they often show up after a heavy load on the muscles, for example after a long jogging round or mountain hike.

The pain is usually felt to be very strong, and often it is so severe that movements, or even simple walking, are hardly or not at all possible for a few days. Often remain calf pain "not alone" but it comes at the same time other complaints such as thigh pain , foot pain , knee pain , Achilles tendon pain or pain in the ankle. In addition, in many cases there is a feeling of numbness or tingling in the calves, in some cases those affected also feel the feeling that they can no longer keep their legs still.

Cause leg cramps

A common cause of calf pain is muscle cramps, which can be acute or permanent. Leg cramps occur suddenly and in most cases completely unexpectedly, for example during a yoga class, while jogging or at night while sleeping, and can cause extremely severe pain.

Usually the so-called gastrocnemius muscle is affected in a calf cramp, which is also called the “two-headed calf muscle” and gives the calf its typical shape. In a cramp, the muscle contracts suddenly and hardens; from the outside, you can feel a noticeably hard strand in the muscles during the cramp state. As long as the cramp persists, normal walking is not possible. If the calf muscles are stretched - i.e. the foot is pulled up or pressed by the person concerned or a helper - the cramp usually also dissolves and the pain goes away again, but in some cases a muscle-sore, pulling feeling remains.

Most of the time, calf cramps are harmless and go away relatively quickly as a result of the stretching - but caution is advised in some cases, as the severely impaired movement can lead to dangerous situations, for example in traffic or while swimming, as the person affected could drown in the worst case .

The cause of calf cramps is often an insufficient or excessive strain on the muscles. Accordingly, athletes in particular are often affected by painful cramps in the calf when they use their muscles heavily or too much. If you then sweat profusely, the body loses a lot of fluid and important minerals such as magnesium or potassium, which are, however, necessary for the muscles to function properly. If the muscles are under-challenged, this often leads to calf cramps, especially those who sit at a desk or on the sofa a lot during the day and do not provide sufficient compensatory movement are often woken up by severe pain in the calf at night. But nocturnal calf cramps also occur quickly,

Calf cramps occur more often with age, which is partly due to the fact that muscles shorten over the years and muscle mass is reduced - unless it is counteracted with targeted sport. Since the feeling of thirst subsides in old age, older people also tend to drink too little and to eat one-sidedly - which promotes a lack of fluids and electrolytes and thus quickly leads to leg cramps. The lack of minerals also affects pregnant women due to changes in the metabolism and hormonal balance; especially in the second half of pregnancy, too little magnesium often leads to cramps at night.

Taking diuretics, too, often leads to leg cramps, as does high blood pressure medication, chemotherapy agents or contraceptives, for example. If the calf cramps occur again and again in a very painful form and last for a relatively long time, nerve damage can also be the trigger, which can be caused , for example, by diabetes , alcoholism or disorders in the brain and spinal cord. Here the cramps sometimes not only occur in the calves, but also in the feet or other areas of the body; other symptoms such as numbness or swelling can also be an indication of a serious illness.

Other possible causes of calf cramps are chronic kidney weakness, varicose veins, thrombosis or poor blood circulation in the leg (peripheral arterial disease). Muscle diseases are also less common for calf cramps, which in many cases are hereditary and are often recognized in childhood and adolescence. It is typical here, among other things, that those affected can often only relax their tense muscles (e.g. the clenched fist) with a great deal of effort.

Cause tension

If calf pain occurs chronically or repeatedly, it is often caused by tension in the muscles or the layer of connective tissue (fascia) surrounding the muscles. The pain often causes a boring or pulling feeling and in most cases intensifies after more intense exertion such as jogging or hiking. In some cases the symptoms become so severe that movements are hardly bearable or possible. There are very different triggers and areas for tension in the calf:

Pain in the superficial muscles of the calf

If, for example, the two superficial, rear, large calf muscles "Musculus gastrocnemius" and "Musculus soleus" are affected, those affected usually experience extensive pain, which - depending on the cause - can radiate either on one side or on both sides of the entire calf. In addition, in many cases there is Achilles tendon pain, if the pain starts from the gastrocnemius muscle, it often extends to the hollow of the knee and the uppermost part of the calf, which can also lead to knee pain. If the pain occurs on both sides, a so-called hollow back is the trigger in most cases, as shifting the weight backwards while standing as well as moving leads to permanent tension in the muscles. As a result, pain in the calf occurs with prolonged exertion,Lower back pain , thigh pain, or knee pain.

Even those who frequently walk, stand or sit with their knees bent, by constantly folding their feet and lower legs backwards, promote permanent tension and thus pain on both sides. In some cases, calf pain also occurs when the flexor muscles of the leg are constantly kept tense while accelerating in the car, for example, or the office chair is set too high and the toes are pressed on the floor, which often leads to foot pain or pain during prolonged exertion Toe pain is coming.

In addition, bilateral calf pain can occur if physical activity is not carried out properly, for example by not moving the feet sufficiently when riding a bike or by not relaxing the muscles enough during strength training, but only tensing them. Wearing the wrong shoes can also have serious consequences and lead to severe pain on both sides of the calf - caused both by too hard, stiff soles in which no natural foot movement is possible, as well as by high heels that cause the calf muscles to stretch permanently tense and even shortened.

In addition to bilateral pain, the superficial calf muscles can also cause unilateral pain. In many cases, these are caused by poor posture, for example when the weight is shifted to the other leg over a longer period of time as a result of an injury to one leg. This type of inclination can often be observed in everyday life, because many people find it easy or particularly "casual" to shift their weight onto one leg - but this also risks tension in the muscles and connective tissue of the supporting leg.

Tension in the toe flexors

Pain in the calves can also result from the long toe flexor muscle (Musculus flexor digitorum longus), which lies on the tibia side of the lower leg The foot is turned outwards. If the toes are bent over and over again or over a longer period of time, permanent tension is created in this muscle too, which ultimately leads to calf pain, but sometimes also to toe pain or pain on the soles of the feet .

The curved toes are mostly caused by the long-term wearing of unsuitable shoes - here, shoes with high heels come into consideration, in which the toes have to be constantly curved and pulled in order to get hold. At the same time, however, the unnaturally held feet are also loaded with the entire body weight - which quickly leads to tension and the resulting calf pain.

In addition to the wrong shoes, "toe bending" is not a rare phenomenon as such, because some people reflexively claw their toes when they are afraid, agitated or in stressful situations, but also, for example, while working hard at the PC - in most cases without it themselves to notice.

Calf pain in the posterior tibial muscle

Pain in the calves can also be caused by the so-called tibialis posterior muscle ("rear shin muscle"), which is one of the deep calf muscles and on the one hand lifts the inner edge of the foot and on the other hand lowers the sole of the foot towards the ground (plantar flexion). In this form of calf pain, the symptoms usually occur longitudinally in the middle of the calf, often accompanied by foot pain in the longitudinal arch of the foot.

If they show up on both sides, they are often associated with “arched feet” and “bowlegs” (medical: genu varum), which can either be inherited or, for example, acquired through accidents, and the cause of these misalignments can also be in the hip - or foot area or, in rare cases, inflammation, bone metabolism disorders and systemic diseases. If, on the other hand, the pain in the posterior tibial muscle is noticeable on one side, in most cases there is an often unnoticed, regularly assumed crooked posture in which you push the pelvis to one side and thereby automatically pull the foot up on the other side more inwardly.

Pain from tension in the connective tissue

However, pain in the calves can come not only from the muscles, but also from the connective tissue in the calves. In this case, the symptoms are usually not clearly localizable and explainable, but they can be very uncomfortable and annoying and are often accompanied by itching, tingling or burning in the calves. Often those affected also have the feeling that the calf is extremely tense or that it is less strong than usual. The cause of tension in the connective tissue of the calves are mostly past injuries, some of which are no longer present, such as bruises, strains or Breaks, but also scars from previous operations.

Torn muscle fiber in the calf

A torn muscle fiber can also cause pain in the calf. This occurs when one or more muscle fiber bundles in the calf tear as a result of permanent high stress on the muscles (e.g. in competitive sports) or sudden overexertion (e.g. when starting a sprint or jumping off). Therefore, a torn muscle fiber is one of the most common sports injuries, with sports that are particularly often affected in which you run alternately and then stop abruptly (e.g. football, tennis, badminton) or the rapid strength of the muscle is used, such as in running .

A torn muscle fiber usually manifests itself as a quickly shooting calf pain or the feeling that something is tearing, in rarer cases the symptoms do not appear until hours after the tear. Walking, running and especially standing on tiptoe cause severe, stabbing pain, often these movements are no longer possible. Externally, a torn muscle fiber is difficult to recognize at the beginning, in some cases a dent appears in the corresponding place, in the further course the calf swells in many cases.

In addition to permanent muscle strain and sudden overexertion of muscles, direct force (e.g. kicking) can lead to a ruptured muscle fiber. The risk of an injury, the lower the elasticity of the muscles, which is why inadequate or unsuitable stretching exercises or too short a warm-up phase before exercise are often the cause of a torn muscle fiber. In addition, there are other possible triggers such as wrong running shoes, misaligned feet, too short a regeneration phase, too quick a return to sport after a previous injury, muscle hardening or muscle shortening.

Calf pain from a herniated disc

Calf pain can also result from a herniated disc, which is very common in this country and in most cases can be treated well without surgery. The intervertebral discs are cartilage-like, flexible tissue with a gelatinous core that lies between the vertebral bodies of the spine and ensures the mobility of the back and the cushioning of shocks. In the case of a herniated disc, this soft core escapes from the cartilaginous connective tissue ring of the intervertebral disc and thereby presses on the neighboring nerves, which causes the characteristic severe pain.

The symptoms of a herniated disc vary depending on in which area and in which extent it occurs. In many cases, sufferers feel a sharp, deep back pain or pain in the thigh that can radiate into the calves or even feet. This form of pain is often called "lumbago" or " sciatic pain"“, Which lasts a long time and often increases in motion. In addition, there is sometimes a tingling sensation or a feeling of numbness in the corresponding regions, and paralysis is also possible. A herniated disc rarely occurs spontaneously, but usually has a history in which the affected person has been dealing with painful tension or degenerative joint changes (osteoarthritis) over a long period of time.

In the development of a herniated disc, the aging process plays a central role, because the intervertebral discs lose their elasticity with increasing age, as a result of which the outer connective tissue ring of the intervertebral disc loses its strength and gives way more quickly. In addition, there are other risk factors such as obesity, lack of exercise, constant sitting and heavy lifting, which put additional strain on the intervertebral discs and thus promote herniated discs. Weak back and abdominal muscles can also lead to a herniated disc. In addition, a herniated disc often occurs during pregnancy, as hormonal changes cause more water to be stored in the intervertebral discs, which in turn leads to greater instability.

Calf pain - thrombosis

If the pain in the calf occurs suddenly, a deep vein thrombosis can also be the cause, a distinction being made here between thrombosis in the superficial veins and thrombosis in the deep veins. In superficial vein thrombosis or phlebitis, in most cases a varicose vein is inflamed, which can lead to the formation of a thrombus (blood clot), which can be very dangerous because the blood flow is obstructed.

But even an actually healthy vein can become inflamed, which in this case indicates a possibly more serious illness - and should therefore be taken seriously. Superficial phlebitis is relatively common and, if left untreated, can develop into a deep vein thrombosis or, in serious cases, lead to a life-threatening pulmonary embolism if parts of the blood clot detach and enter a pulmonary vessel with the blood.

With deep vein thrombosis, the blood clot is found in the veins that run inside the leg. Typical signs here are sudden, severe swelling of the ankle, lower leg and / or the whole leg as well as severe, pulling pain. In addition, the affected leg feels warm and unusually heavy or tense, and externally there is often a bluish or reddish discoloration of the skin. In most cases of deep vein thrombosis in the leg, the symptoms occur below the point where the thrombus is located and are usually even worse when standing and sitting - lying and elevating the affected person, on the other hand, helps in most cases to alleviate the symptoms.

A deep vein thrombosis can lead to serious complications: On the one hand, there is a risk of pulmonary embolism, in which small pieces of the blood clot get into the lungs, block the vein and thereby block the blood flow. In untreated leg vein thrombosis, pulmonary embolism is relatively common and manifests itself as shortness of breath, chest pain , cough (also with bloody sputum), racing heart , palpitations, Sweating or sudden fainting. In the event of a severe embolism, the heart suddenly has to “fight” the “disruptor” in the pulmonary circulation, which means that there is a risk of cardiac insufficiency and thus an acute danger to life. If a thrombosis is not discovered or if the therapy does not work, this can lead to permanent weakness of the veins, which in more severe cases causes deep wounds in the skin that heal poorly ("open leg"), through which it closes severe pain and infections quickly.

There are a number of risk factors for a deep vein thrombosis, in addition to varicose veins, for example, obesity, blood clotting disorders, cardiac arrhythmias such as atrial fibrillation, pregnancy or the “pill” - whereby a particularly high risk is assumed here if women parallel to the Smoking ingestion. Even those who sit with bent legs for a long period of time (for example at a desk or on a plane) are more likely to develop deep vein thrombosis. The tricky thing is that in some cases a thrombosis remains symptom-free or only causes symptoms after a while - therefore, if a thrombosis is suspected or if there is severe or persistent calf pain, a doctor should be consulted to be sure, because whether this is actually present or not.

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