Pain in the lower leg


Dear readers,
we have structured the topic according to the various causes:

Unilateral / bilateral lower leg pain

  • unilateral lower leg pain
  • bilateral lower leg pain

According to location:

  • posterior lower leg pain
  • anterior lower leg pain
  • external lower leg pain
  • internal lower leg pain

Pain in the lower leg can be triggered by various diseases and injuries. The exact location of the pain is important when looking for the cause. Purely orthopedic clinical pictures must be distinguished from diseases of the vascular system. In addition to the frequently observed muscular causes, defects in the bony structures can also lead to pain in the lower leg.


Chronic or frequently recurring pain in the lower leg is in most cases caused by tight muscles, problems in the area of ​​the muscle fascia or connective tissue defects in the skin or subcutaneous tissue. The most common causes are:

  • Muscle tension or cramps
  • Leg vein thrombosis
  • peripheral arterial disease

In most cases, pain is described primarily on the back of the lower leg (calf). In the case of calf pain, which is often due to purely musculoskeletal (originating from the muscle or bone) Causes can be traced back, the affected patient usually feels pulling or piercing pain. Under heavy strain (e.g. jogging or hiking) this pain usually increases in intensity. If the pain occurs suddenly while exercising, a torn muscle fiber in the lower leg could also be causing the pain.

Pain in the lower leg is triggered in many cases by tension or spasmodic continuous contractions of the calf muscles. In particular, the large calf muscles that shape the calf are often the cause of pain in the lower leg. Pain caused by the calf muscles is usually not limited to the calf but radiates to the hollow of the knee. In addition, knee pain may occur.

Patients who are often affected by pain in the lower leg should pay attention to the circumstances under which the pain problem occurs, which measures are used to weaken or intensify it and whether the pain occurs on one side (one leg) or on both sides.

Varicose veins can also cause pain in the lower leg. Read about this: Pain from varicose veins.

Figure pain in the lower leg

Figure Lower leg pain: Right lower leg (front and back), causes (A-F)

Pain in the lower leg
I - Right lower leg
II - Right lower leg
Rear (calf)

  1. Kneecap - patella
  2. Sole muscle -
    Plantaris muscle
  3. Kneecap ligament -
    Ligamentum patellae
  4. External calf muscle -
    Gastrocnemius muscle,
    Caput laterale
  5. Internal calf muscle -
    Gastrocnemius muscle,
    Caput mediale
  6. Tibia anterior muscle -
    Tibialis anterior muscle
  7. Achilles tendon -
    Tendo calcaneus
    A varicose veins (Varicosis)
    B - Frequent improper sitting
    C - hollow back posture
    D - torn hamstring
    E - Incorrect footwear
    F - thrombosis in the leg
    (Vascular disease, blood clots)

You can find an overview of all Dr-Gumpert images at: medical illustrations

Causes of bilateral calf pain

Hollow back posture

A hollow back can be the cause, especially in the case of pain in the lower leg that occurs on both sides in the calf area. In this case, the patient concerned shows an over-erect posture with the upper body bent back strongly. As a rule, the affected person also pushes his knees backwards strongly. No or hardly any involvement of the pelvis and trunk can be observed while walking or running. These postural errors cause constant tension in the calf muscles, which causes pain in the lower leg. Pain in the front thigh, knees and lumbar spine can often be observed.

Read more on this topic at: Hollow back posture

Frequent incorrect sitting

Pain in the lower leg, which mainly affects the calf, is also triggered in many patients by frequent sitting with the knee excessively bent.
The direct consequence of this incorrect posture is tension, which makes it difficult to adequately straighten the knees while walking and running. In addition, these patients often experience pain on the back of the thighs.

Stand and walk with your knees bent

Many patients with thigh pain have a habit of standing and walking with their knees permanently bent.
In the course of this, the muscles of the calf are often tensed. Tension and calf pain are the result in many cases.

Improperly done sport

For example, cycling without moving your feet, overstressing weightlifting or monotonous muscle training are often the cause of pain in the lower leg.

Hard, hardly flexible shoes

In some patients, they cause pain when they restrict the movement of the foot too much.
Shoes with particularly soft footbeds can help.

Causes of unilateral calf pain


Unilateral pain in the lower leg occurs more frequently in people who shift their body weight onto one leg while standing. In some cases this is just a temporary relieving posture in the event of injuries to the other leg. For many patients, however, this crooked posture is a habit that in the long term can not only lead to pain in the lower leg but also to back problems.

Restless Legs Syndrome

Burning pain in the lower leg, which persists even at rest, often indicates diseases of the connective tissue of the skin and subcutaneous tissue. Pain in the lower leg that results from tension in the connective tissue is usually much more diffuse and cannot be precisely localized. In most cases, this pain is burning and accompanied by sensory disturbances such as tingling and itching. In addition, the affected patients often notice a feeling of tension and weakness. Pain in the lower leg that comes from the connective tissue or the muscle fascia can be differentiated from normal tension pain in that it often occurs at rest and can lead to restless legs.

Much more information on this topic is available at: Restless Legs Syndrome


In the event of acute, severe or sharp pain in the lower leg, a doctor should be consulted as soon as possible. Organic causes for the occurrence of this pain phenomenon must be ruled out urgently in these cases. The sudden onset of pain in the area of ​​the lower or thigh can be an indication of vascular diseases such as thrombosis in the leg, venous or arterial insufficiency, a smoker's leg, the so-called peripheral arterial occlusive disease (PAD for short) or wound infections.

You can find a lot more information under our topic: thrombosis

Compartment syndrome in the lower leg

In many cases, lower leg pain can be caused by what is known as the compartment syndrome. The compartment syndrome describes a disease in which, when the skin and soft tissue cover is closed, increased tissue pressure leads to a reduction in tissue blood flow. After a while, this reduced blood flow results in neuromuscular disorders. Tissue damage is also possible. In addition to the lower leg, the forearm is also at risk of compartment syndrome in many patients. Direct causes for its development are bruises or edema in individual muscle compartments caused by acute trauma or heavy stress from physical activity. In the course of this, the muscle group limited by fasciae swells and the pressure within the individual compartments increases. Typical symptoms of the lower leg compartment syndrome besides pain are hardened muscles and sensory disorders.

Read more on this topic at:

  • The compartment syndrome, compartment syndrome on the lower leg


  • Calf pain

Internal pain in / on the lower leg

Pain on the inside of the lower leg is comparatively rare.
The most common causes are irritation or injury to muscle fibers. In most cases, the symptoms are only short-lived and subside by themselves if you take a few days' rest. However, misalignments of the legs, particularly bow legs, can lead to muscle pain due to excessive strain. If pain on the inside of the lower leg occurs more frequently, you should be examined by a doctor. If there is a misalignment in the area of ​​the pelvis or the foot, this should be compensated for with insoles.
A doctor should also be seen if symptoms such as swelling or redness occur in addition to the pain, without being caused by a trigger such as injury.

External pain on / in the lower leg

Pain on the outside of the lower leg can originate from different parts of the leg.
If the symptoms are preceded by an accident such as an twisted foot, pain on the outside of the lower leg can indicate a fracture of the fibula. As a rule, the outer malleolus, the lower end of the fibula, is injured and the pain is hardly possible. If you have any complaints you should consult a doctor as soon as possible.
If the pain on the outside of the lower leg occurs without injury, a variety of possible causes are possible. Often there is an injury or irritation to the lateral lower leg muscles that run from the fibula to the outside and bottom of the foot. An injury can result from excessive stress, for example when playing football.
If, on the other hand, the pain on the outside of the lower leg only occurs after a certain walking distance and soon subsides again when you stop, there may also be calcification of the blood vessels.
If the pain persists even at rest and there is also redness and overheating of the outer lower leg, inflammation is likely to be the cause.


The iliotibial ligament syndrome (ITBS) is also known as the runner's knee and describes an irritation of the leg in which runners typically experience pain in the area of ​​the outer knee joint. The pain is usually the result of overstressing a tendon plate that leads from the pelvis over the entire outside of the thigh via the knee joint to the lower leg.
It is typical of the iliotibial ligament syndrome that the symptoms suddenly set in after a few kilometers when running. The pain is usually stabbing and often so severe that walking has to be interrupted.
At rest and when walking normally, however, the person affected is usually symptom-free. If symptoms occur, the amount of training should be reduced and, if necessary, strengthening and stability exercises should be carried out regularly.

You can find a lot more information under our topic: Iliotibial Band Syndrome (ITBS)

Lower leg pain

On the back of the lower leg there is mainly muscle tissue, which forms the calf muscles. The blood-supplying arteries and the blood-draining veins are also located in the depths.
Pain in the lower leg can basically originate from any of these structures. Muscular complaints are the most common.
The calf muscles serve on the one hand to lower the foot and on the other hand to stabilize the leg in relation to the foot in the ankle. Therefore, the calf muscles are constantly used both when walking and when standing. Improper or excessive strain can easily lead to minor injuries to the muscles, which leads to pain in the lower leg.
In addition, the muscles of the calf are most commonly affected by cramps, which can also be very painful.
If the arteries are the cause of pain in the lower leg, in most cases this is due to a narrowing of the inner walls of the vessels due to calcification.
This manifests itself in pain that occurs after initially walking for a long time and subsides when you stand still.
If the calcification increases - the main risk factor is cigarette smoking - this leads to a constant shortening of the pain-free walking distance. However, pain in the lower leg may also indicate a blood clot has blocked a deep vein. In the case of a so-called deep vein thrombosis, the affected leg often swells. Patients who have been immobile for a long time, such as after a long-haul flight or an operation, are particularly at risk. If there is a corresponding constellation, a doctor should be consulted as soon as possible. Short-term pain in the lower leg without further symptoms or risk factors, on the other hand, almost always has a harmless and self-limiting cause.

Leg vein thrombosis

In the case of a leg vein thrombosis as the cause, the localization of the pain is very different depending on the location of the thrombus, but usually a calf or sole pain can also be triggered. Often the pain occurs slowly and is of a pulling quality with a simultaneous feeling of tension. There are certain risk factors for thrombi such as smoking, diabetes, little exercise, the birth control pill, pregnancy and obesity. Causes are often long-term bed rest, for example after a major operation, heart disease, vascular disease, certain medications (diuretics, neuroleptics, pill) and blood formation disorders. A sign of pain in the lower leg from a thrombus is when the pain can be significantly alleviated by elevating the leg. A visit to the doctor is essential in this case.

Further information can be found under our topic: Leg vein thrombosis

Lower front leg pain

Pain in the anterior lower leg can originate from the shin and the periosteum surrounding the bone and from the anterior muscle group of the lower leg. Because of its location just under the skin, the front edge of the shin is prone to painful injuries. If you bump your shin, you will first suffer a sharp, pale pain on the front lower leg, which is followed by a dull, throbbing pain.
This can last for a few days, depending on the severity of the injury. On the other hand, pain in the front lower leg that only occurs when walking is usually caused by the muscles.
The front muscle group on the lower leg arises from the shin and runs to the top of the foot, where the tendons sometimes run down to the toes. These muscles are used to lift the foot and are therefore used with every step. If there is an injury, overuse, or inflammation in these muscles, it typically manifests itself as pain in the front lower leg. As a rule, the symptoms subside after a few days by taking care of yourself and, if necessary, cooling. If the pain persists after two weeks, a doctor should be asked for advice.

Shin splints

Shin splint syndrome is a symptom complex that occurs particularly in athletes and is characterized by pain in the lower leg.
Typically, after exercise or on the following day, pain occurs on the anterior inner side of the lower leg, directly on the edge of the shin. The symptoms usually subside at rest and reappear under stress such as walking.
The shin splint syndrome is not a uniform clinical picture but a typical constellation of symptoms that can have various medical causes. On the one hand, it can be the result of excessive exercise. On the other hand, the pain in the lower leg can express itself through incorrect training such as running in shoes that do not fit the foot.
The third possible cause of shin splint syndrome is inflammation or injury to muscle fibers.

You can find all information about this clinical picture at: Shin splints

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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  • Lumedis - orthopedic surgeons
    Kaiserstrasse 14
    60311 Frankfurt am Main

You can make an appointment here.
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For more information about myself, see Lumedis - Orthopedists.

Often accompanying symptoms

Swelling of the lower leg

Swelling of the lower leg combined with pain can have several causes. Water retention in the lower legs, called edema, can cause severe swelling. If, for example, stockings that are too tight are worn, they can constrict and cause slight and precisely localizable pain.
Another and consistently more likely cause of the swelling is inflammation, which in addition to pain can also lead to overheating and reddening of the painful area. The inflammation can be caused locally by the penetration of microorganisms - as a result of an injury, for example, or a result of a thrombosis of the leg. One then speaks of thrombophlebitis, in which the blood vessel in which a clot is located becomes inflamed. The entire lower leg is then often reddened, overheated and painfully swollen.

Please also read the article: How to recognize a thrombosis and thrombosis prophylaxis

Numbness or tingling in the lower leg

  • A feeling of numbness or a tingling sensation in the lower leg can be a sign of a latent undersupply of blood to the lower leg, i.e. a harbinger of PAD (peripheral arterial occlusive disease) if the feeling occurs primarily after walking or running.
  • Another possibility that could cause tingling or numbness is spinal stenosis. This leads to a constriction of a nerve in the immediate vicinity of the spinal cord. It would be typical, however, that the numb or tingling area can be clearly defined and the symptoms usually only appear on one side. Even with spinal stenosis, the symptoms mainly occur after physical activity.
  • However, if the symptoms are also present at rest, a herniated disc must be assumed, which affects the same nerves as in spinal stenosis. Here, too, the affected area can be clearly defined and the symptoms usually only occur on one side. Furthermore, in the absolute majority of cases, the herniated disc is accompanied by pain in the area affected by numbness.

Burning in the thigh

A burning sensation in the lower leg is usually the symptom of an insufficient supply of the lower leg with blood and therefore also with oxygen. The pain is roughly comparable to immersion in very cold water. The underlying disease is peripheral arterial occlusive disease, or PAOD for short. It is an expression of arteriosclerotic calcification of the leg arteries and ensures that affected patients have to pause after walking distances of several hundred meters in order to allow sufficient blood flow to the lower legs again. To disguise this fact, patients used to behave as if they were stopping in front of shop windows to take a closer look at the products on display. This is why the PAOD is popularly known as “intermittent claudication”.

These articles might also interest you: Diagnosis of PAD

What role do the fasciae play in lower leg pain?

The fasciae as the sole cause of pain in the lower leg play a subordinate role. Inflammation of the fascia is possible, but rarely. On the other hand, causes such as calf muscle hardening or the so-called “jogger shin” are more likely. Here, the shortening of the calf muscles puts a tensile load on the muscles on the shin side and tries to keep the foot in a normal position by tension. This permanent tension in the shin muscles ultimately leads to pain in the tensed muscles.

The most common causes again in detail

Muscle tension, muscle cramps

Usually the pain is localized in the affected muscle groups, especially the calves, and of moderate to severe intensity. Those affected feel the pain predominantly as pulling or piercing. Muscle cramps and strains affect all age groups and are mostly related to sport.
However, they can also arise from a hollow back posture, frequent and incorrect sitting, incorrect footwear and general overloading of the muscles.

You can find more under our topics: Muscle spasms

Unilateral muscle tension and muscle cramps

Unilateral muscle tension also affects certain muscle groups and is of the same intensity and quality as bilateral muscle cramps. In addition to improper and excessive strain in sports, a tilted or relieved posture due to an injury to the other leg is the cause.

PAOD (synonym: intermittent claudication)

Peripheral arterial occlusive disease (PAOD), also known as intermittent claudication, can be divided into different types, which also change the localization of pain. With a B-type, the person affected feels pain in the thigh because the vascular occlusion is already there. The lower leg is usually affected in the O-type and the foot in the U-type. It is also a sharp pain that usually starts suddenly. Men are also more likely to be affected than women, and the risk increases with age. Causes include a lack of exercise, smoking, high blood pressure, diabetes and disorders of lipid metabolism. Relief can be achieved by lowering the leg or standing between movements.

Further information can be found under our topic: peripheral arterial occlusive disease (PAD)

Nocturnal pain

If there is pain in the lower leg at night that tears the person out of sleep, then in most cases it is a leg cramp.
This usually does not last longer than a few minutes and is harmless despite the sometimes severe symptoms. If cramps occur frequently, magnesium can be taken as a preventive measure. However, if pain in the lower leg only regularly occurs at night and there is no calf cramp, this is very unusual and should be clarified by a medical examination.
The most common causes of lower leg pain are triggered or at least exacerbated by movement of the legs. Causes of nocturnal pain at rest can be, for example, inflammation or rheumatic diseases and, in extremely rare cases, malignant diseases of the bone.

Pain at rest

In the case of pain in the lower leg at rest, it is important to distinguish whether it occurs exclusively at rest, or whether it persists and walking is intensified.
An occlusive disease of the blood vessels in the legs, for example, leads to pain in the lower leg in the initial stages, which only occurs after a long walk. As the disease progresses, this pain-free walking distance is usually increasingly shortened, so that ultimately pain in the lower leg occurs at rest.
However, if there is suddenly pain at rest without such a history, other causes are more likely. Typically, inflammations such as erysipelas (erysipelas) are expressed by pain that occurs during exercise and at rest. On the other hand, a muscular cause, which is generally responsible for pain in the lower leg, typically causes fewer or no discomfort at rest.

What role do the fasciae play?

Fascia are the connective tissue skins that usually surround several muscles on the body.
On the lower leg, there are four muscle groups separated from one another by fascia. In the muscle membranes there are sensory cells that perceive and convey pain stimuli. The fasciae therefore play an important role in the perception and transmission of pain signals to the brain, for example when muscle fibers are injured or inflamed.
In addition, the fascia itself can be affected by damage and diseases, which can also result in pain in the lower leg. The fasciae can stick together as a result of a lack of exercise but also as a result of excessive strain, which impairs the gliding ability of the muscle fibers. The result can be pain in the lower leg.
The most important measure to prevent or treat fasciae damage is therefore sufficient healthy exercise.
If necessary, additional exercises to loosen the fascia can be performed.

You can find a lot more information under our topics:

  • Fascia
  • Fascia training

Can this also be a herniated disc of the lumbar spine?

A herniated disc in the lumbar spine (lumbar spine) often causes pain that radiates from the back into the leg.
Additionally it can too

  • Paresthesia
  • Numbness
  • Muscle weakness

come on the leg. However, if there is only pain in the lower leg, a herniated disc in the lumbar spine is very unlikely to be the cause.
In the case of a herniated disc, one of the nerve roots that transmit sensations from the leg to the brain is pressed off. These nerves each have a typical supply area, so that a herniated disc leads to a typical distribution pattern of pain in the leg. In most cases, there is band-like pain that extends from the outer thigh over the lower leg to the inner top of the foot.

You can find a lot more information under our topics:

  • Symptoms of a herniated disc of the lumbar spine
  • Herniated disc of the lumbar spine

Can that also be spinal stenosis?

Spinal stenosis, in most cases, affects the lumbar spine and typically manifests itself as pain in the legs that occurs when walking.
Both legs or just one side can be affected. Usually the pain starts from the lower back and extends over the buttocks into the legs. If the pain is only in the lower legs, spinal stenosis is unlikely to be the cause. In the case of pain in the lower leg that only occurs after walking a certain distance, however, a vascular occlusive disease of the legs should also be considered. The symptoms of this can resemble spinal stenosis, although with this disease it also happens that pain initially only occurs in the lower leg.

You can find much more information under our topics:

  • Symptoms of spinal stenosis
  • Spinal stenosis

How painful is a tattoo on the lower leg?

When a tattoo is done, there are some parts of the body that are more painful than others. This is due, among other things, to the different thicknesses of the skin and the density of pain receptors, which can vary greatly.
A tattoo on the lower leg is usually relatively less painful. There are exceptions, in particular, if the knee is also included when tattooing.
Some people also report that having a tattoo on the front of the lower leg in the shin area as well as on the ankles is more painful.
However, regions such as the chest or neck are often stated to be significantly more painful. In general, however, pain is ultimately a subjective experience that can be individually pronounced for each person.
Some people report that they hardly felt any pain when they got a tattoo on their lower leg. For others, however, the small needle sticks were characterized by extreme pain. In particular, the opinion is often expressed that women can endure pain better than men because they have to endure the severe pain during childbirth. In addition, the experience of pain is also influenced by other factors, for example whether you are afraid of tattooing and how good and experienced the tattoo artist is. Ultimately, your own experienced pain intensity when getting a tattoo on your lower leg remains uncertain in advance.


In general, pain in the lower leg can be relieved with classic pain relievers such as

  • Ibuprofen
  • aspirin
  • Paracetamol

to treat. However, since the pain often has a specific cause, it makes more sense to eliminate it.

In the case of a muscle strain, there are ointments that not only relieve the pain but also promote the healing of the muscle. An example of this would be the horse ointment or Voltaren®.
In addition to medication, immediate cooling, elevation of the leg and a period of rest would also be indicated in this case.
For other diseases such as thrombosis, a medical examination is necessary to avoid complications such as pulmonary embolism. For this, the doctor will prescribe blood-thinning drugs that dissolve the clot.