Causes of Lower-Leg Pain

Pain in the lower leg can be caused by overuse, overexertion, or trauma from a fall or blow. The lower leg also can be affected by heart and circulatory diseases, such as congestive heart failure, or blood clots and inflammation in the veins of the legs.

Phlebitis

Phlebitis is the inflammation of a vein, sometimes accompanied by a blood clot. The inflammation can cause aching, swelling, and redness in the lower portion of one leg. A blood clot in one of the veins of the leg can further increase swelling by blocking the flow of blood back to the heart. Phlebitis requires immediate medical attention to keep a potential clot from moving into the heart or lungs.

Narrowing of the Arteries

Narrowing of the arteries occurs when plaque builds up on the arteries in the leg. That creates an obstruction of blood flow into the leg and keeps the lower leg muscles from getting enough oxygen. The condition, called intermittent claudication, usually occurs in older adults and heavy smokers. Activity may cause pain, because the working muscles fail to get the oxygen they need. The pain is relieved shortly after exercise or activity is stopped. If you have symptoms of intermittent claudication, see your doctor.

Shin Splint

A shin splint is an overuse injury that causes inflammation of the shin muscles. Shin splints are a common injury among runners and other athletes, store clerks, warehouse and factory workers, and others who are on their feet all day on hard concrete floors.

The most common causes of shin splints include:

• Muscle imbalance (the calf muscle is stronger than the shin muscles)
• A tight Achilles tendon (the tendon at the back of the heel and ankle)
• Not enough shock absorption during high-impact exercise
• Running on the balls of the feet, without allowing the heel to touch the ground
• Doing too much activity too fast

Symptoms include aching at the front or inner side of the lower leg. Generally there is no swelling, redness, or bruising. The pain may begin suddenly or build slowly.

Compartment Syndrome

Compartment syndrome is a dangerous condition that can occur after a strong blow to the leg. Sometimes, besides a painful bruise, there can be internal bleeding that causes swelling, putting pressure on the nerves and blood vessels to the muscles of the calf. Symptoms of compartment syndrome may begin with mild pain and swelling that can build to a loss of color, feeling, and pulse; severe pain; paralysis; and swelling so bad that the skin in the area of the bruise turns shiny. If the more serious symptoms appear, prompt treatment is crucial to prevent or lessen permanent nerve damage. If not treated immediately with surgery to relieve pressure, the swelling of compartment syndrome can permanently damage the nerves and muscles of the leg. When this happens, the person is left with weak or functionless muscles and a condition known as “drop foot.” The person loses the ability to lift the foot, which seriously affects walking.

Stress Fracture

Stress fractures can result from repetitive or sudden movement and overuse of the lower leg. They are a common result of high-impact activities. Stress fractures are hard to detect on x-rays until 10 to 14 days after the fracture begins. You may notice a sudden spreading pain in your shin during or after exercise. In most cases, people with stress fractures can pinpoint exactly where the pain is coming from by pressing on the spot.

Depending on the bone, some stress fractures should be checked with x-rays until fully healed, usually about 6 weeks. During this time, rest the leg by avoiding high-impact activities. Generally, low-impact activities, such as walking, bicycling, or swimming, are safe to do while a stress fracture heals.

Caring for Lower-Leg Pain

• For most lower-leg pain, use the RICE method and pain medications.
• For chronic swelling in both legs without pain, try raising your legs. Call the doctor and ask if you need to be seen.
• For shin splints, rest the leg for 3 to 6 days, then do only low-impact activities (bicycling, walking, swimming) to keep up strength and prevent recurrence. When the aching has gotten better, you can return slowly to your usual activities.
• Wrap the ankle and shin with elastic wrap for support.
• Achilles tendon stretches and exercises can be helpful to strengthen the front of the leg.
• An ice massage four times a day can help. Freeze water in a paper cup, tear away the cup to expose the ice, and massage the ice over the painful area for 10 to 15 minutes.
• Wear shoes with good support and cushioning. Replace your athletic shoes regularly to make sure they are not overly worn.