Calf Tendon Pain: What You Need To Know To Get It Healed

Related Conditions To Calf Tendon Pain

In some cases, pain localized in the calf area can indicate another, more serious condition. Ignoring your symptoms may cause you to let a health disorder go untreated, which paves the way for severe complications. 

Below, we’ll look at some of the conditions most often linked to calf tendon pain. Nonetheless, it is important to keep in mind that this symptom can also arise from other disorders, including:

• Sciatica. When the sciatic nerve is irritated, entrapped, compressed, or damaged, you may experience pain, tingling, numbness, and weakness in several aspects of your leg, including the calf. 
• Peripheral neuropathy. This condition refers to pain, numbness, and weakness caused by damage to nerves in the peripheral system (those located outside the brain and the spinal cord). If one or more of the nerves that innervate the lower leg are affected, you may experience tendon pain caused by nerve damage. Peripheral neuropathy is more commonly caused by diabetes, but risk factors include smoking, nutritional deficiencies, exposure to toxins, and certain viruses. 
• Deep vein thrombosis (DVT). This is a serious condition that occurs when blood clots form in the deep veins of the leg. It requires immediate medical attention. 
• Compartment syndrome. Compartment syndrome happens when excessive pressure builds within your muscles. This pressure may interrupt blood flow, causing serious muscle and nerve damage that leads to intense calf pain. 

Now, let’s look at the most commonly diagnosed conditions when experiencing calf tendon pain.

Baker’s Cyst

Baker’s cyst (BC) is not a true cyst; it’s a fluid-filled sac that develops at the back of the knee. It occurs when the body produces joint fluid in excess, which can happen due to conditions like arthritis or cartilage damage.

Typically, BC causes discomfort and stiffness in and around the knee area. You might also feel a bulge or a sense of tightness behind the knee. It is estimated that nearly 26% of people with knee pain have a Baker’s cyst. If left untreated, more severe symptoms may develop, which include sharp pain, especially when bending or straightening your knee.

BC can also cause pain in the lower leg and around the tendons and muscles in the calf. This usually occurs when the cyst ruptures or leaks, which causes the fluid to shift down the calf, triggering tension and inflammation in the tendons.

Tendonitis

Tendonitis is a condition that develops when one or more tendons become inflamed. Some of the most common causes of tendonitis include repetitive movements and sudden injury. For example, athletes who often run or jump may put undue pressure on their tendons, which can cause inflammation.

Symptoms of tendonitis typically include pain, swelling, and difficulty in moving the affected area. You’ll notice that these symptoms get worse when you use the affected tendon. Tendonitis is also a common cause of calf tendon pain. 

This condition can affect any of the tendons in the lower leg, from the Achilles tendon (which we will see below) to the posterior tibial tendon. When these tendons become inflamed, you may experience symptoms like a sharp or burning pain in the calf, as well as discomfort when moving your lower leg or ankle. Inflamed tendons are also affected by swelling and stiffness, which can put pressure on the calf muscle, limit their range of movement, and make muscle movements more difficult.

Achilles Tendonitis or Rupture

The Achilles tendon – the largest tendon in the body – is a strong fibrous cord that connects the muscles of the back of your calf to your heel bone. This tendon is extraordinarily resistant and capable of withstanding loads of multiple times a person’s body weight. Nonetheless, stress, injury, overuse, and poor posture can take a toll on this tendon’s ability to remain strong, healthy, and flexible. 

That’s when conditions like tendonitis, tears, and ruptures occur:

• Achilles tendonitis occurs when the Achilles tendon becomes inflamed. 
• Tears occur when the fibers of the tendon become damaged. This is also called a strain. 
• Ruptures, or complete tears, occur when there is severe damage to the tendon. This type of injury can lead to excruciating pain and permanent disability. They may also require surgery.

There can be many causes that lead to pathologies of the Achilles tendon. However, some of the most common causes include overuse, sudden increases in physical activity, or not warming up properly before exercising. The main symptoms include pain and swelling around the heel and difficulty walking or moving the foot. 

In severe cases, you might experience an inability to bear loads on the ankle or poor stability, leading to weak calf movements and reduced athletic performance. Sudden tendon tears may also be accompanied by a “popping” sound at the time of injury.

Achilles Tendinopathy

Achilles tendinopathy refers to a disorder that occurs when the Achilles tendon degenerates due to repetitive strain. Unlike tendonitis, which is an acute inflammation, tendinopathy is a chronic condition. Usually, it derives from the fact that the tendon isn’t able to repair itself or heal after microtrauma (i.e. minor tears). This could be due to inadequate recovery periods, excessive stress, or inhibited self-healing capabilities. 

Factors such as continuous pressure on the tendon, aging, changes in training regimes, or wearing unsuitable footwear can also contribute to the development of this disorder. Given the essential role that the Achilles tendon plays in the functioning of the calf structure as a whole, it is easy to see how this condition can lead to chronic pain and dysfunction of the lower leg and ankle. Today, it is estimated that around 6% of the population will have some form of Achilles tendinopathy during their lifetime.

Calf Muscle Strain

A calf muscle strain is a common injury that typically occurs due to sudden bursts of acceleration or rapid changes in direction, which are movements that can overstretch the muscles in your calf. Two muscles in particular, the gastrocnemius and the soleus, are often affected.

• The gastrocnemius muscle, due to its length and complexity, is especially prone to injury. A strain in this muscle might cause instant calf pain, swelling, or even bruising. In severe cases, you might hear a “pop,” followed by extreme pain that gets in the way of normal activities like walking.
• The soleus muscle helps lift the heel off the ground and stabilizes your posture during movements. Strain in this muscle often manifests as deep soreness or tightness, particularly when pressing on your Achilles tendon or walking on your tiptoes.

Both muscle strains can result in minor to moderate tears in the muscle fibers. Given how these muscles are connected to the different tendons in the calf, it is easy to see that the damage will extend to these bands of connective tissue, ultimately adding complexity to this disorder. If not addressed, worsening damage can lead to discomfort, weakness, limited motion, and a higher risk of recurring injuries.

Plantaris Tendonitis

Plantaris tendonitis refers to inflammation in the plantaris tendon, which, as we have seen above, is a thin section of connective tissue running through your calf. Not everyone has this peculiar tendon – but, if present, it can suffer injuries and contribute to calf issues. Typically, this tendon can become inflamed due to an overuse injury or if other components of the calf around it are inflamed, damaged, or irritated. 

Common symptoms of plantaris tendonitis are similar to those typical of tendonitis: pain, tenderness, and swelling in the calf area, particularly along the inside of the leg. However, what makes plantaris tendonitis a complex condition is the fact that it is seldom recognized and often underdiagnosed – even when imaging tests like MRI are used. This can let inflammation and damage go untreated, which can lead to complications.

Popliteus Tendinitis

Popliteus tendonitis involves inflammation in the popliteus tendon, which links your thigh bone to the popliteus muscle, which is located under the knee. This tendon and its corresponding muscle work together to stabilize and rotate your knee. 

Inflammation to this tendon often occurs as a consequence of overuse or tears, and it can cause discomfort above the calf and around the side and back of the knee. These symptoms can worsen when walking or running downhill. In rare instances, this tendon can rupture due to trauma – like a direct blow to the knee – leading to knee pain and bleeding in the knee joint.

When To Seek Professional Help

As we have seen above, calf tendon pain can emerge as a result of overuse or muscle fatigue. Think, for example, of the discomfort you experience after an intense workout or extreme physical activity.

However, in some cases, there’s much more to this symptom. Because of this, if you are in doubt about the nature of your pain or your symptoms seem to be getting worse, you should immediately contact your healthcare provider. 

Some telltale signs that may be time to seek professional help include:

• Your pain is persistent or worsening.
• The pain is so severe that it gets in the way of your everyday activities, thus causing disability.
• The calf or ankle areas are swollen. 
• You are unable to walk comfortably on the affected side.
• You have experienced a severe, direct blow to the lower leg.
• You can see a deformity in the lower leg.
• You are experiencing calf pain that occurs at night or during periods of rest.
• You experience signs of an infection, such as fever, warmth, and redness.
• The pain is accompanied by tingling and numbness.
• The leg is unusually cold or pale.
• You have abnormal fluid retention.
• You have other unusual symptoms, like breathing problems. 
• You have other conditions, like varicose veins.

If you have been sitting for a long time (e.g. you’ve been on a flight) and you are now experiencing the symptoms of deep vein thrombosis (DVT), you should seek immediate medical care. These symptoms include swelling, pain, tenderness, and red or discolored skin in the affected leg, often with a sensation of warmth. It is important to keep in mind that, without adequate medical care, DVT can lead to recurring episodes of DVT in around 25% of people, post-thrombotic syndrome in 43% of patients, and death in 6% of cases.

Diagnosing The Pain In The Tendon Calf

Diagnosing calf tendon pain isn’t always straightforward. Many patients are often dismissed, and their symptoms are classed as a consequence of exertion. However, if you have noticed that the pain is getting worse, you should ensure to undergo all necessary tests and obtain an accurate diagnosis. Here are some of the diagnostic tools your doctor may use to determine what’s causing your calf tendon pain.

Physical Examination

A physical examination is often the first step in diagnosing what’s causing your calf tendon pain. Your healthcare provider will attentively inspect your lower leg and use methods like palpation to gauge an understanding of your symptoms’ location, nature, and severity.

This involves putting gentle pressure on your leg to identify any areas of swelling or tenderness. They’ll also watch out for signs of warmth or redness, indicating possible inflammation, and test the flexibility of your foot, ankle, and knee to assess your range of motion.

What’s more, your doctor will check your reflexes and pulses in your leg, ankle, and foot to determine the quality of the blood circulation in your leg, as well as the responsiveness of your nervous system. This part of the test is used to rule out systemic disorders that may be affecting one or more of your body’s systems, such as neurological conditions. 

If your doctor suspects a specific condition, specialized diagnostic tests may be recommended. For example, if your symptoms point to an Achilles tendon rupture, the Thompson test can help confirm this diagnosis. In this test, as you lie down with your foot extended off the table, your doctor will squeeze your calf muscle. If your toes don’t flex downward, it may be because of a ruptured Achilles tendon.

Imaging Of The Area

Following your initial physical examination, your doctor may recommend you undergo certain imaging tests. These will provide a detailed look at the complex structures in your calf, helping to pinpoint the source of your pain. There are several types of imaging tests: some are more efficient in diagnosing soft tissue abnormalities, while others are better equipped to show problems with your bones.

• X-rays. These are the most common imaging techniques, used to determine if any bone breakages or fractures are causing your discomfort.
• MRIs. Magnetic resonance imaging can help provide a clearer image of the soft tissue of your calf, including tendons, muscles, and ligaments.
• Ultrasound. A vascular study, which is a specific type of ultrasound, assesses the blood flow in your veins and arteries, ensuring a clot isn’t the root cause of your pain.

Examining Medical History

Understanding your medical history is a crucial part of diagnosing calf tendon pain, and it can even highlight some tendencies and genetic factors that may make you more prone to this symptom. 

Before seeing your healthcare provider, prepare some notes about your symptoms that could aid in the diagnosis. Key information includes:

• When the pain first started
• The nature of the pain – sharp, dull, etc.
• If it occurs at rest or during certain activities
• If the pain intensifies in the night
• Any other symptoms you’re experiencing, like numbness or swelling

These details alone provide valuable clues about what’s causing your discomfort. For example, pain during specific activities may point to a tendon strain, while numbness could indicate nerve-related issues.

Nonetheless, your overall health history is equally important. Be sure to tell your doctor about any recent or old injuries, health conditions, and medications you are taking.

Blood Tests

Blood tests are effective tools in the diagnosis of calf tendon pain, particularly when inflammation or clots are suspected. Some key tests your doctor may order include:

• The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests, both of which can detect general inflammation often associated with infections.
• The D-dimer test, used in diagnosing conditions like deep vein thrombosis (DVT) or pulmonary embolism. A positive result indicates the presence of protein fragments (D-dimers) released during blood clot breakdown, pointing to the existence of a clot in your body.

Together, these tests provide valuable insights and ensure a more precise analysis of your clinical picture, which can guide treatment decisions.

Immediate Treatment Of A Painful Calf

As we have seen above, in most cases, calf tendon pain is caused by an inflammatory condition – like tendonitis – that leads to discomfort, swelling, and pain. Fortunately, there is a lot that can be done at home to ease your symptoms, reduce inflammation, and improve the function of your lower leg, ankle, and foot. 

Below, we’ll look at the most commonly used self-care methods, which can help you during flare-ups or when your pain isn’t so intense.

Rest, Ice, Compression, Elevation (RICE) Method

The RICE method is often the first course of action in managing calf pain. It can help lessen acute inflammation and manage flare-ups of pain if you have been diagnosed with a chronic condition. 

RICE stands for Rest, Ice, Compression and Elevation:

• Rest supports the healing process and reduces strain on the leg, thus preventing further injury.
• Ice limits the circulation of blood around the area of injury, which reduces swelling and boosts the function of your joints. 
• Compression provides support to the leg and further reduction of swelling and inflammation by restricting blood flow.
• Elevation also reduces swelling and inflammation. Be sure to elevate the lower leg above the heart for more efficient results. 

Over the past years, controversies have emerged against this method, pointing to the fact that reducing blood circulation slows down the healing process. A study conducted in 2012 concluded that there isn’t enough evidence to determine the effectiveness of RICE therapy.

If your pain is severe or worsening, be sure to look beyond at-home remedies and immediately contact an expert healthcare provider.

Stretches

Stretches could be a beneficial at-home treatment to manage pain, especially when performed correctly and regularly. Some of the benefits of stretching exercises for your calves include:

• Improved muscle flexibility and strength, thus boosting overall musculoskeletal health
• Preventing injuries caused by reduced mobility like falls or trips
• Improved blood circulation, which enhances the supply of healing oxygen and nutrients
• Relieved pressure on nerves, ligaments, and tendons, which can improve lower limb function

While these benefits are an excellent starting point to regain the health of your calf, don’t forget that proper technique is of vital importance. Without the guidance of an expert, it is often too easy to cause further injury to your lower legs, thus aggravating your condition.

Conventional Treatment Options For Calf Pain

If at-home remedies have not worked and your calf pain is debilitating or worsening, your doctor may recommend you follow a treatment plan, which usually involves medications, physical therapy, and lifestyle modifications. 

Although surgery isn’t common for this type of problem, certain surgical interventions may help repair severe damage, such as a torn Achilles tendon. In the following sections, we’ll look at how the different conventional methods are used to address calf tendon pain.

Physical Therapy

Physical therapy tends to be the first port of call when it comes to choosing a therapeutic approach for orthopedic conditions. 

When it comes to treating calf tendon pain, some conditions, like Achilles tendonitis and strains, may respond well to targeted exercises and physical therapy as a whole. On the other hand, while physical therapy is generally recommended to improve overall health, conditions like DVT don’t benefit as much from this approach. 

Because of this, a physical therapy plan is usually prescribed following a comprehensive diagnosis, and it is used not only to help a patient manage pain but address the root of the problem. 

The approach taken will largely depend on what’s causing the calf tendon pain. 

• If the pain is due to Achilles tendonitis, your healthcare provider will guide you through exercises aimed at making your calf muscles stronger and the Achilles tendon more flexible, according to guidelines.
• Physical therapy can also help address risk factors that may be aggravating your condition, such as poor posture, abnormal mechanics, weak or tight muscles, and joint problems. 
• If you suffer from disorders like arthritis, an occupational therapist can also help you better understand how to take part in daily activities without placing your calf’s components under undue pressure. 
• Most physical therapists will also recommend gentle passive stretching and isotonic exercises to support the healing process of tendon injuries like tears.

Surgery

Although surgery is rarely needed to treat calf pain, surgical interventions may help address certain problems that lead to this symptom, such as a ruptured Achilles tendon, blood clots, or a blocked artery. 

Several interventions may be recommended if you have a severe orthopedic issue or your pain is getting in the way of your daily life:

• Calf lengthening procedures. A tight calf can lead to a whole host of problems, including heel pain (e.g. Achilles tendinopathy), plantar fasciitis, and deformities like flat feet, bunions, and neuromas. Calf lengthening operations aim to improve the range of extension of the tendons in the calf to alleviate these problems. It is carried out by cutting through the tendon to “release” it. Some common lengthening procedures include:
  • Medial head of gastrocnemius release (MHGR)
  • Gastrocnemius lengthening
  • Soleus lengthening
  • Achilles tendon lengthening (rarer, usually carried out to correct severe deformities in children)
• Tendon repair procedures. Tendon repair procedures are used to address severe tears or ruptures in the tendons. During the procedure, the surgeon performs a cut through the skin to access the tendon, and then the ends of a torn tendon are re-joined together surgically. It is more commonly performed for Achilles tendon damage.

Other surgical procedures may also be used to address specific problems. For example, if your calf pain derives from a compressed or entrapped sciatic nerve, decompression surgery can help restore the nerve’s function while easing your symptoms. 

If you are an athlete, these surgeries can help you return to sports in 62%-96% of cases. However, you should not underestimate the lengthy and painful recovery times associated with invasive interventions, as well as the risks they may bring. Generally, surgery should only be considered as a last option.

Medications

There are several types of medications that can be used to ease calf tendon pain. These include:

• NSAIDs. Nonsteroidal anti-inflammatory drugs, like ibuprofen or naproxen, work by inhibiting enzymes called cyclooxygenases. These enzymes produce prostaglandins, which trigger pain and inflammation. By reducing prostaglandins, NSAIDs effectively alleviate swelling and pain in the calf tendon. Other types of painkillers that block pain signals from the injured site may also be used. 
• Corticosteroids. Corticosteroid injections deliver anti-inflammatory medication directly into the affected area. These steroids mimic the action of cortisol, a hormone naturally found in the body that suppresses immune responses and inflammation. 
• Opioids. These are powerful pain relievers that bind to opioid receptors in the nervous system and the brain. This binding action gets in the way of pain signals, significantly reducing your perception of pain in the calf tendon. 

Other medications may also be prescribed for specific conditions. For example, if your pain derives from nocturnal cramps, your doctor may recommend muscle relaxants, calcium channel blockers, or magnesium supplements. On the other hand, if you have DVT or a blood clot, blood thinners (anticoagulants) like Xarelto (rivaroxaban) may be used. 

It’s important to keep in mind that these medications should only be used to ease flare-ups and only under the supervision of a specialist. If you suffer from chronic calf tendon pain, taking these medications regularly can expose you to a whole host of side effects, including an increased risk of heart attack and stroke, gastric ulcers, and, in the case of opioids, addiction, overdose, and death.