Lower leg pain has a wide range of causes, from overworked muscles to circulation problems to nerve issues. The location of the pain, when it started, and what makes it better or worse are the biggest clues to figuring out what’s going on. Here’s a breakdown of the most likely reasons your lower leg hurts and what to watch for.
Shin Pain From Overuse
If the pain runs along the inner edge of your shinbone, you’re likely dealing with shin splints. This is one of the most common causes of lower leg pain, especially if you’ve recently increased your activity level, started running on harder surfaces, or changed your footwear. The hallmark is exercise-related pain along the lower two-thirds of the inner shin border, with tenderness that spreads across more than 5 centimeters of bone. The pain typically shows up during or after activity and improves with rest.
Shin splints exist on a spectrum with stress fractures, and the two can be hard to tell apart. The key difference is how focused the pain is. Shin splints produce broad, diffuse tenderness along the shinbone, while a stress fracture causes sharp, pinpoint tenderness in a small area (less than 5 centimeters). If your pain has been getting worse despite rest, or if pressing on one specific spot reproduces intense pain, a stress fracture is more likely and worth getting evaluated.
Calf Tightness and Achilles Problems
Pain in the back of your lower leg often points to the calf muscles or the Achilles tendon. A calf strain usually comes on suddenly during activity, with a sharp pulling sensation. Achilles tendinopathy, on the other hand, builds gradually and comes in two varieties depending on where it hurts.
If the pain is right where the tendon attaches to your heel bone, that’s insertional tendinopathy. It often comes with noticeable morning stiffness that loosens up as you move around. If the pain sits higher, roughly 2 to 6 centimeters above the heel, that’s non-insertional tendinopathy. You may be able to feel a thickened area or small nodule in the tendon when you press on it. Both types affect athletes and non-athletes alike, and both tend to develop when the tendon is asked to handle more load than it’s adapted to.
Muscle Cramps, Especially at Night
If your lower leg pain comes as sudden, involuntary tightening of the calf muscle, you’re experiencing a cramp. These are especially common at night and can wake you from a dead sleep. The muscle contracts hard, sometimes for seconds, sometimes for minutes, and the area can feel sore for hours afterward.
Nocturnal leg cramps are linked to several everyday factors: sitting for long periods, overusing your muscles, standing on hard floors like concrete, and poor posture during the day. Low potassium levels can also trigger cramps and may signal a more significant issue if they happen frequently. Some experts recommend magnesium or a vitamin B complex supplement for recurring cramps, though results vary from person to person. Staying hydrated, stretching your calves before bed, and moving around more during the day all help reduce how often they strike.
Circulation Problems That Cause Leg Pain
Two circulation-related conditions commonly cause lower leg pain, and they feel quite different from each other.
Peripheral Artery Disease
If your calves cramp or ache predictably when you walk and the pain goes away within a few minutes of stopping, that pattern is called intermittent claudication. It happens because narrowed arteries can’t deliver enough blood to your leg muscles during exertion. The pain is reproducible: the same walking distance triggers the same discomfort, and rest reliably brings relief. This is most common in people over 50, smokers, and those with diabetes or high blood pressure. A simple, painless test called an ankle-brachial index compares blood pressure in your ankle to blood pressure in your arm. A reading below 0.9 suggests some degree of artery narrowing.
Chronic Venous Insufficiency
When valves in your leg veins weaken, blood pools in your lower legs instead of flowing efficiently back to your heart. This creates a heavy, achy, tired feeling that worsens as the day goes on, particularly after prolonged standing. Early on, you might not see any visible changes. As it progresses, you may notice spider veins, then varicose veins, then swelling in your ankles and lower legs. Over time, the trapped blood causes skin changes: a reddish-brown discoloration, itching, flaking, and skin that feels leathery. In advanced stages, the skin becomes fragile and vulnerable to slow-healing ulcers. Burning, tingling, and nighttime cramping are also common symptoms.
Nerve-Related Lower Leg Pain
Not all lower leg pain starts in the leg itself. Sciatica, caused by compression of a nerve root in the lower back, can send shooting, burning, or tingling pain all the way down into the calf and foot. This type of pain often gets worse with sitting or bending and may come with numbness or weakness.
A less well-known cause is compression of the peroneal nerve, which wraps around the bony knob just below the outside of your knee. When this nerve gets pinched, it can cause pain, numbness, or tingling on the outer side of the lower leg and the top of the foot. In some cases, it weakens your ability to lift your foot upward. The symptoms can look similar to sciatica, which is why it sometimes takes targeted testing to pin down exactly where the nerve compression is happening. People who frequently cross their legs, wear tight boots, or have recently lost significant weight are more prone to peroneal nerve issues.
Blood Clot Warning Signs
Deep vein thrombosis (DVT), a blood clot in one of the deep veins of the leg, is the cause you don’t want to miss. The classic combination is pain, swelling, redness, and warmth in one lower leg. The calf may feel tight and tender, especially along the inner part of the leg where the deep veins run. One practical sign: if the affected calf measures 3 or more centimeters larger than the other leg (measured about 10 centimeters below the kneecap), that asymmetry is significant.
Your risk is higher if you’ve been immobilized recently, had surgery in the past 12 weeks, have active cancer, or have a history of prior clots. A DVT requires urgent medical attention because a piece of the clot can break off and travel to the lungs.
When Lower Leg Pain Is an Emergency
Most lower leg pain is manageable and not dangerous. But certain patterns demand immediate evaluation. Get emergency care if you can’t walk or bear weight on the leg, or if you notice pain combined with swelling, redness, and warmth in the calf (the DVT pattern described above).
A rarer but serious emergency is compartment syndrome, where pressure builds inside a muscle compartment faster than it can be released. This typically follows a significant injury like a fracture. The pain is severe and out of proportion to what you’d expect, and it gets worse when the muscle is stretched. Late signs include numbness, weakness, and pale or cool skin below the affected area. If your lower leg feels tight as a drum after an injury and the pain keeps escalating despite elevation and rest, that warrants an emergency room visit.
You should also schedule a prompt visit if one leg looks pale or feels noticeably cooler than the other, as this can signal compromised blood flow that needs evaluation before it worsens.