Lower Leg

Discomfort in your lower leg can make simple tasks, like getting the mail or grocery shopping, more difficult. At times, the pain in your leg could just be a minor nuisance, but it could also be an indication that there is a serious problem. The following are common problems associated with pain in your lower leg:

Achilles Tendinitis

Achilles tendinitis is inflammation of the Achilles tendon, the fibrous tissue that connects the heel to the calf muscles. This condition is often caused by irritation of the tendon and typically affects those who play sports. However, older individuals who suffer from arthritis may also be affected. Achilles tendinitis is typically the first stage of an Achilles tendon injury and should be treated right away. Without treatment, the tendon can tear or rupture, which may require surgery.

Causes of Achilles tendinitis

Achilles tendinitis is usually caused by straining the Achilles tendon through intense activity or a sudden increase in exercise.

Individuals who play basketball often develop Achilles tendinitis as a result of pivoting, jumping, and running. These repetitive movements put pressure on the tendon and can gradually wear it down over time.

Increasing the intensity of your workouts may also lead to the development of Achilles tendinitis. This is commonly seen in long distance runners who do quite a bit of uphill running. Similarly, if you start exercising more frequently you may also develop the condition due to overuse of the tendon. Not stretching properly before exercise can also make the tendon more prone to injury.

Achilles tendinitis is also common in individuals whose feet have a flattened arch, as this places more stress on the tendon. The condition can also be triggered by arthritis, as joint pain can cause one to compensate by putting more pressure on the Achilles tendon.

Achilles tendinitis symptoms

Symptoms of Achilles tendinitis include:

  • Creaking sound when touching or moving the tendon.
  • Dull pain when walking or standing on the toes.
  • Stiffness around the tendon in the morning that gradually decreases throughout the day.
  • Swelling and inflammation around the ankle.
  • Tenderness around tendon.

Treatment of Achilles tendinitis

Achilles tendinitis can typically be treated at home by following the R.I.C.E. treatment method:

  • Rest: Rest the tendon by avoiding activities that irritate the tendon or increase swelling. However, this does not mean you should be completely inactive for long periods of time, as this can cause stiffness in your joints. It’s still important to stretch in order to maintain strength and flexibility and partake in activities that don’t put direct pressure on the tendon, such as bicycling.
  • Ice: Apply ice to the affected area for 20-minutes at a time, every couple hours, as needed, to reduce swelling and pain.
  • Compression: Use compression bandages to help reduce swelling.
  • Elevation: Elevate your ankle above the level of your heart to help reduce swelling. It is particularly important to do this at night while you sleep. Simply place a pillow or two under your ankle to keep it elevated.

Once the tendon has healed, be sure to gradually return to more strenuous activities. If flattened arches contributed to the injury, wear shoes with appropriate support or inserts to prevent the condition from progressing or recurring.

If these non-surgical treatments have not been able to provide relief of symptoms after several months, surgery may be performed to remove inflamed tissue. However, this is not usually recommended unless all other options have been exhausted. Consult your doctor for more information about surgical treatment options.

Achilles Tendinosis

Achilles tendinosis is a chronic condition in which tiny tears develop in the Achilles tendon. This tearing occurs gradually due to overuse or strain and typically affects individuals in their 30s and 40s. As tears form in the tissue, blood flow to the area is reduced, limiting the ability for the tendon to heal. The condition can be very painful and will become progressively worse without treatment.

Causes of Achilles tendinosis

Achilles tendinosis is typically caused by overuse of the tendon, making sudden movements that strain the Achilles tendon, or wearing improper footwear.

It is common for individuals who play sports that involve pivoting, jumping, running and pushing off from the toes (such as basketball or football), to develop Achilles tendinosis. These sudden movements place strain on the Achilles tendon and, over time, can cause the tendon to deteriorate, making it more likely for small tears to form in the tissue. Failing to stretch and warm-up before exercising, can also lead to Achilles tendinosis, as the tendon is more susceptible to injury when it is tight.

Wearing shoes with high-arches that stretch the Achilles tendon, or switching back and forth between heels and flats, can also strain the tendon and contribute to tendinosis.

Achilles tendinosis symptoms

Symptoms of Achilles tendinosis may include:

  • Development of scar tissue that may cause a noticeable thickening of the tendon.
  • Pain and soreness around the Achilles tendon, located between the heel and calf.
  • Reduced range of motion in the ankle.
  • Stiffness and creaking of the tendon, particularly in the morning.
  • Swelling around the Achilles tendon.
  • Weakness or pain when pushing off from the toes.

Treatment of Achilles tendinosis

Achilles tendonitis can be treated by resting the foot and reducing stress on the tendon, allowing it time to heal. Over-the-counter pain relievers, like aspirin and ibuprofen, can be taken during this time to reduce pain and inflammation.

A boot or brace may also be worn to keep the foot in place and help with healing. However, the foot shouldn’t be kept immobilized for too long at a time as this can cause the tendon to become weaker and prone to further injury. For this reason, physical therapy and stretching exercises are an equally important and necessary part of treatment.

It typically takes at least a few weeks for the tendon to heal. However, since blood flow is particularly important in the healing process, it may take longer if you have poor circulation. If the condition is severe and non-surgical treatments have not worked after several months, surgery can be performed to either remove scar tissue or transfer another tendon to help restore function. Contact your doctor to discuss your options and determine which treatment would be most appropriate for you.

Achilles Tendon Rupture

An Achilles tendon rupture is a complete tear of the fibrous tissue that connects the heel to the calf muscle. This is often caused by a sudden movement that overextends the tendon and usually occurs while running or playing sports such as basketball or racquetball. Achilles tendon rupture can affect anyone, but occurs most often in middle-aged men.

Causes of Achilles tendon rupture

An Achilles tendon rupture is often caused by overstretching the tendon. This typically occurs during intense physical activity, such as running or playing basketball. Pushing off from the foot while the knee is straight, pivoting, jumping, and running are all movements that can overstretch the Achilles tendon and cause it to rupture.

A rupture can also occur as the result of trauma that causes an over-stretching of the tendon, such as suddenly tripping or falling from a significant height.

The Achilles tendon is particularly susceptible to injury if it is already weak. Therefore, individuals who have a history of tendinitis or tendinosis are more prone to a tendon rupture. Similarly, individuals who have arthritis and overcompensate for their joint pain by putting more stress on the Achilles tendon may also be more susceptible to an Achilles tendon rupture.

Achilles tendon rupture symptoms

Symptoms of an Achilles tendon rupture include:

  • A popping sound that accompanies the sudden pain when the injury occurs.
  • Inability to stand on tip-toes or push off when walking.
  • Pain, swelling, and bruising near the heel.
  • Stiffness.
  • Sudden and severe pain in the back of the ankle or calf when the injury occurs, as if struck by a hard object.
  • Visible gap in the tendon above the heel bone.
  • Weakness.

One way to confirm the injury is to squeeze the calf muscles while lying on your stomach. If the foot does not point or move when the calf muscles are squeezed, then the tendon is likely torn.

An MRI or ultrasound can also confirm that the Achilles tendon is in fact torn.

Treatment of Achilles tendon rupture

A ruptured Achilles tendon can be treated with or without surgery.

Non-surgical

Non-surgical treatment typically involves wearing a brace or cast for the first six weeks following the injury to allow time for the ends of the torn tendon to reattach on their own. Over-the-counter medications, such as ibuprofen or aspirin, may be taken during this time to reduce pain and swelling. Once the tendon has reattached, physical therapy will be needed to strengthen the muscles and tendon. A full recovery is usually made within four to six months.

Surgical

During surgery, the ends of the tendon are stitched back together. Following the surgery, a brace or cast must be worn for about six weeks to allow the tendon time to heal. Physical therapy will then be needed to help maintain strength and flexibility of the muscles and tendon.

Contact your doctor to determine which treatment would be best for you.

Achilles Tendon Tear

An Achilles tendon tear is a separation of the fibrous tissue that connects the calf muscle to the heel bone. A tear often occurs during intense physical activity and is most common among athletes and those in their 30s and 40s.

Causes of an Achilles tendon tear

A tear in the Achilles tendon is typically caused by a sudden movement that puts stress on the tendon. However, a tear can also be trauma-induced and result from a fall in which sudden force is placed on the tendon, causing it to overstretch.

Overuse of the tendon or repetitive motion that wears the tendon down over time may contribute to the injury. Also, individuals with a history of tendonitis or tendinosis are more susceptible to a tear since the tendon has already been injured.

When your Achilles tendon is tight and inflexible, it is more prone to injury. Refusing to stretch before exercising can increase your risk of an Achilles tendon tear.

Achilles tendon tear symptoms

Tearing of the Achilles is often described as a sharp pain accompanied by a popping sensation felt behind the ankle. There is typically swelling and bruising around the torn tendon, and it may be difficult to point your toes. Walking and standing on your toes may also be painful.

Treatment for an Achilles tendon tear

A torn Achilles tendon can be treated with or without surgery. Individuals who are not very active, and those who do not want to take the risks involved with surgery, often choose non-surgical treatment; athletes and those with very active lifestyles typically choose to have the surgery.

Non-surgical

Non-surgical treatment for a tear in the Achilles tendon usually involves keeping your foot immobilized in a cast or boot for 4-6 weeks. This allows time for the ends of the torn tendon to reattach and heal. Once the cast is removed, physical therapy will be needed to strengthen the tendon and increase flexibility. While non-surgical treatment may be successful, there is a higher risk for another tear, and it’s possible that the tendon may not regain the strength it once had.

Surgical

During surgery, the ends of the torn tendon are stitched together, and a splint is worn for the next 4-6 weeks while the tendon heals. As with any surgery, there are risks associated with the procedure, including infection and scarring. However, the risk of another tear is reduced, and it is more likely for strength to be fully regained in the tendon.

If you have a torn Achilles tendon, consult your doctor about your treatment options. Each case is slightly different and your doctor will be able to help you decide which treatment is best for you.

Bursitis of the Achilles Tendon

Achilles tendon bursitis, or retrocalcaneal bursitis, can affect anyone, but is typically a foot condition in athletes, especially runners. Because of similar symptoms, this condition is often confused with Achilles tendinitis. At times, bursitis of the Achilles tendon can occur in conjunction with Achilles tendinitis. When both conditions are present, it is referred to as Haglund's syndrome.

If you are a runner and are experiencing pain in your lower leg and heel area, you may be suffering from Achilles tendon bursitis. Proper treatment of the condition can help relieve the pain and allow your leg to heal.

Causes of Achilles tendon bursitis

Bursitis of the Achilles tendon is caused by the irritation and inflammation of the retrocalcaneal bursa, a small fluid-filled sac located in the back of the ankle that acts as a cushion and lubricant for the ankle joint.

Possible causes of Achilles tendon bursitis include:

  • Aging: Factors related to the aging process, including the onset of rheumatoid arthritis and gout, can deteriorate the bursa.

  • Overuse of ankle: Excessive walking, uphill running, jumping, and other aggressive exercise regimens, especially without proper conditioning, can cause irritation to the bursa.

  • Trauma: Sudden injury to the ankle joint, or trauma caused by rigid or improperly fitted shoes, can increase the chances of developing bursitis.

Symptoms of bursitis of the Achilles tendon

Unlike Achilles tendinitis, which tends to manifest itself slightly higher on the lower leg, Achilles tendon bursitis usually creates pain and irritation at the back of the heel.

Possible signs of bursitis of the Achilles tendon include:

  • Difficulty to rise on toes: Standing on your toes or wearing high heels may increase the heel pain.

  • Inflammation and tenderness: The skin around your heel can become swollen and warm to the touch. Redness may be visible.

  • Pain in the heel: Pain tends to become more prominent when walking, running, or touching the inflamed area.

  • Stiffness: The back of your ankle may feel a little stiff due to the swelling of the bursa.

Achilles tendon bursitis treatment

Many times, Achilles tendon bursitis can be treated with home care. However, if self-care remedies do not work, your doctor may need to administer additional treatments.

Home care

The most important thing you can do to help your healing is to refrain from activities that could further aggravate the bursitis.

Typical home-care treatments for Achilles tendon bursitis include:

  • Anti-inflammatory medication: Take over-the-counter pain medication, like aspirin or ibuprofen, to reduce pain and swelling.

  • Heel wedges: An over-the-counter or custom heel wedge can be placed in your shoe to minimize stress in the Achilles tendon.

  • Ice: Apply ice or other cold therapy to your sore heel several times a day.

  • Rest: Limit your activity on the injured leg; avoid putting pressure on it whenever possible. Also, elevate your leg during non-use to help reduce the swelling.

The above remedies may be used on their own or in combination with others on the list.

Physician-administered treatments

If the above self-care remedies are not effective, you should visit your doctor for additional treatment.

Possible Achilles tendon bursitis treatments your doctor may administer include:

  • Immobilization: If the bursitis is combined with Achilles tendonitis, your doctor may place a temporary cast on the ankle to prevent movement and allow it to heal.

  • Physical therapy: Exercises may be used to improve the ankle's strength and flexibility.

  • Steroids: Injection of steroids into the retrocalcaneal bursa (not the Achilles tendon) may be necessary.

  • Surgery: In very rare circumstances, surgery may be needed to remove the retrocalcaneal bursa; however, this is typically a last resort.

Lower Leg Fracture (Broken Leg)

A lower leg fracture, or broken leg, refers to the break of one or both of the bones in the lower leg: the tibia and fibula. The tibia, which is the larger, weight-bearing bone of the lower leg, is the most common broken long bone. However, the fibula, which is the smaller of the two bones, can also break.

Many times, when the larger tibia bone is fractured, the smaller fibula is also fractured.

Causes of broken leg

Trauma to, or an unnatural rotation of the tibia or fibula, can cause a broken leg. Most lower leg fractures occur following an accident or sporting injury, but occasionally overuse causes small cracks in the bone; these are known as stress fractures. It typically takes a lot of force to break the tibia; however, bones weakened by osteoporosis and other diseases may break with less force.

Common causes of a lower leg fracture include:

  • Car, truck, motorcycle, or other motor vehicle accidents.
  • Contact sports (especially in football, soccer, and rugby).
  • Other traumatic blows to the lower leg.
  • Overuse, including overtraining (can cause stress fracture).
  • Severe twist of leg.
  • Skiing accidents.
  • Slips and falls.

Lower leg fracture symptoms

In many cases, the major symptoms of a lower leg fracture will be obvious. However, there are situations where it is difficult to determine if the leg is actually broken. In these cases, an X-ray is needed to determine if there is a fracture. The main symptoms of a broken leg include:

  • Bone Protrusion: If your leg's bone has broken through your skin, you have a compound fracture.
  • Leg Deformity: If your leg appears to bend at the point of injury instead of just at the knee or if the bottom portion of your leg is twisted, these are significant signs that it is broken. Also, if your injured leg suddenly seems shorter than your uninjured leg, you may have a fracture.
  • Pain: A leg fracture usually causes severe pain. Typically this pain will diminish if the bone is held in place and will increase if the bone is moved.
  • Swelling and bruising: Although these can be a sign of a sprain or other injury, swelling and bruising around the injured area of your leg could indicate that it is broken.

Treatment for a broken lower leg

The treatment for a fracture of the lower leg will vary based on the severity of the injury and the location of the break. Some fractures can best be repaired through surgery and other broken legs can be healed without the need for surgery.

Non-surgical treatment

In some cases, the bone has been displaced and must be realigned prior to immobilization. This process is referred to as reduction. Prior to reduction, you will be given medication for pain relief and muscle relaxation.

Immobilization is the usual course of treatment for a broken leg. When surgery is not needed, the leg is immobilized through the use of a plaster cast or splint. This will allow the bone to be "set" and to have a chance to heal.

Surgical treatment

If reduction and immobilization cannot be achieved through non-surgical treatment, you may need surgery to repair the fracture. In these cases, screws, wires, plates, or stitches may be used to "set" the bone internally. Whether you have surgical or non-surgical treatment of your broken leg, your doctor may prescribe the use of crutches or a cane to help you walk during the healing process.

Shin Splints

Shin splints are a condition that typically occur from physical activity, causing pain and swelling in the front of the lower leg or shin.

Although the term "shin splints" is often used to label any pain at the front of the lower leg, it actually refers to a condition called medial tibial stress syndrome or MTSS. The information below addresses shin splints as related to MTSS.

Shin splint causes

In most cases, shin splints are caused by overuse; however, shin splints may also be caused by improper running techniques or muscle tightness.

Common shin splint causes include:

  • Exercising on uneven ground.
  • Increase of intensity or duration of exercise routine too quickly.
  • Poor running mechanics (excessive forward or backwards lean, landing on balls of feet, outward pointing toes, etc.).
  • Repetitive impact on the lower leg during jogging, running, or hiking.
  • Running or excessive walking on hard surfaces like asphalt or concrete.
  • Starting an exercise regimen after a period of inactivity.
  • Tight or stiff lower-leg muscles.
  • Wearing worn-out or improperly fitted shoes during exercise.

Shin splints symptoms

Shin pain is the most common symptom of shin splints. The pain may be present at the start of exercise and might decrease as the exercise session continues; however, the pain might be worse the day following exercise.

Another possible sign of shin splints is swelling or the formation of lumps or bumps on the shin.

Shin splints treatment

The basic treatment for shin splints is similar to other soft tissue injuries: use the R.I.C.E. guidelines of rest, ice, compression, and elevation to relieve the pain.

Other treatments for shin splints include:

  • Replacing usual workout routine with non-weight-bearing exercises like swimming or cycling.
  • Stretching lower-leg muscles.
  • Taking over-the-counter pain medication (aspirin or ibuprofen) to reduce pain and swelling.
  • Taping the shin to take pressure off of muscles.
  • Using heat therapy on muscles prior to exercise.
  • Wearing shock-absorbing insoles in shoes.

If the above treatments do not relieve the pain associated with your shin splints, visit your doctor for additional rehabilitation techniques.

Stress Fracture of the Lower Leg

Over 50 percent of all stress fractures occur in the bones of the lower leg and foot. A stress fracture in the lower leg is a small crack in either the tibia or fibula caused by overuse and repetitive impact.

Stress fractures typically begin as small cracks in the bone. If left untreated, stress fractures can progress quickly. If you have a sharp pain in your lower leg, it may be due to a stress fracture. Visit your doctor for diagnosis and treatment.

Causes of stress fractures

Stress fractures are typically caused by overtraining or overuse. Repetitive stress on the lower leg from activities like running or jumping can cause fatigued muscles to become less effective in absorbing the impact. The force of the impact is then transferred to the tibia and fibula, causing small cracks and slivers in the bone.

Some sport-related activities that are possible causes of stress fractures include:

  • Basketball.
  • Gymnastics.
  • Running on hard surfaces like concrete or asphalt.
  • Volleyball.

Studies have shown that female athletes are more susceptible to stress fractures than their male counterparts.

In addition to exercise-related causes, certain health conditions like osteoporosis (loss of bone density) and obesity can contribute to the formation of stress factors.

Symptoms of stress fractures

Since stress fractures do not occur from a sudden trauma like other lower leg fractures, they are sometimes difficult to diagnose. In some cases, lower leg stress fractures can be misdiagnosed as shin splints, due to the similarity of symptoms and the fact that x-rays cannot always detect stress fractures.

The main symptoms of stress fractures in the lower leg are generalized pain, discomfort, tenderness, and swelling in your shin or calf.

Treatment of stress fractures

The least invasive treatments of stress fractures can be administered when your fracture is diagnosed early, before it grows into a larger break in the bone.

Rest and time are the main remedies for stress fractures. Your stress fracture should heal on its own if you refrain from weight-bearing or repetitive leg exercises for about six to eight weeks. If you resume the exercises that caused the stress fracture sooner, you risk causing a larger break in the bone, which may require more extensive treatment. Your doctor may prescribe the use of crutches or a cane to allow the stress fracture to heal.

Be sure to visit your doctor immediately if you begin to feel pain in your lower leg.

Tennis Leg

Tennis leg is a term used to describe a tear or strain of the calf muscle. Because of its prevalence in tennis players, the calf strain has been termed "tennis leg," but the injury can occur during various other sports and activities.

Tennis leg causes

Although tennis leg can affect a person of any age or activity level, these calf muscle strains typically occur in middle-aged recreational athletes.

The main cause of tennis leg is a sudden contraction of calf muscles or an overextension of the muscles. As you age, you lose some flexibility in your muscles, which is why it typically affects those in the 30 to 50 age group.

Participating in sports or other physical activities without proper stretching of the calf muscles can also cause tennis leg, as cold muscles do not have the proper elasticity for activity.

Tennis leg symptoms

The main symptoms of tennis leg are a sudden, sharp pain in the leg, which is sometimes accompanied by a popping sound. The degree of these symptoms will vary based on the grade of your calf muscle sprain.

  • Grade I - A minor tear of the muscle, involving no more than 10 percent of the calf's muscle fibers. You may be able to continue your activity because the pain will feel like a minor twinge in your calf. Aching and tightness of the calf muscle will be present for two to five days following your injury.
  • Grade II - Partial tearing of the calf muscle, involving up to 90 percent of the muscle fibers. You will feel a sharp pain and minor to moderate swelling of your calf. The pain will be present when you walk and when you flex your ankle downward, as when pressing a gas pedal. After your injury, aching and tightness of the calf muscle will be present for at least a week.
  • Grade III - A tear of over 90 percent of the muscle, including a complete tear or rupture of the muscle. The most painful of calf muscle sprains. A grade III sprain will cause immediate severe pain in the back of your leg and considerable bruising and swelling.

You will be unable to contract your muscle. In the case of a complete muscle tear, you may see the muscle bunched towards the top of the calf.

Tennis leg treatment

For grade I and II calf muscle sprains, you should be able to treat yourself, using the R.I.C.E. guidelines of rest, ice, compression, and elevation and by taking over-the-counter pain medication, like aspirin or ibuprofen, to reduce pain and swelling.

Limit movements that may aggravate your tennis leg, especially the activity that originally caused the calf sprain. You can also help your healing by incorporating simple calf stretches and heat therapy before any activity.

If you have difficulty walking, experience pain when you are at rest, or do not see an improvement of symptoms after self-care, you may have a grade III muscle calf sprain and should visit your doctor for an examination and additional treatment.

Xanthomas of the Achilles Tendon

A xanthoma is a cholesterol deposit that appears as a painless skin nodule or bump under the skin or on tendons. Achilles tendon xanthomas are small bumps that are attached to your Achilles tendon and appear close to your heel.

In most cases, Achilles tendon xanthomas are not harmful skin lesions and should not affect the function of your lower leg; however, the location of the skin nodules could cause discomfort. The greater concern related to xanthomas of the Achilles tendon is the underlying cause.

Causes of Achilles tendon xanthomas

Xanthomas of the Achilles tendon are caused by very high cholesterol or triglycerides levels. High levels of cholesterol and triglycerides can lead to heart disease, so the appearance of xanthomas is a strong indicator that you should visit your doctor to check your heart health.

If you suffer from familial hypercholesterolemia, a genetic disorder characterized by high cholesterol levels, you have an increased chance of developing xanthomas.

Symptoms of xanthomas of the Achilles tendon

Xanthomas of the Achilles tendon appear as waxy, yellowish to white bumps under the skin along the Achilles tendon. At times, the xanthomas will not be visible without close inspection.

If you are trying to determine if a bump near your heel is Achilles tendon xanthomas, determine if the bump is moving with the tendon as you flex it. Xanthomas of the Achilles tendon will move with the tendon.

Treatment of xanthomas of Achilles tendon

Because Achilles tendon xanthomas are a sign of an underlying cholesterol and triglycerides problem, it is important for you to visit your doctor to treat those issues.

In some cases, a biopsy of the xanthomas may be needed, but typically the skin nodules or lesions are not removed.

If you are suffering from severe pain in your lower leg, you should visit your doctor for an examination and treatment.