Causes of Pain at the Top of the Calf

The top of your calf is a busy anatomic site with a number of muscles, tendons, ligaments, blood vessels and nerves occupying the area. The presence of so many structures equates to several possible causes of pain in the region. These conditions range in seriousness from harmless muscle soreness to a potentially life-threatning blood clot as well as a number of other ailments in between.

Your calf consists of two main muscles called the gastrocnemius and soleus. These and other muscles attach to the bones that make up the back of the knee joint via tendons. One or more of these muscles or tendons can sustain a sudden or chronic overuse injury resulting in upper calf pain.

The discomfort might result from simple muscle soreness due adding a new excercise to your routine or a strain, which describes microsopic tearing to a complete rupture of the involved structure. Walking and climbing stairs usually aggravates the pain with a muscle or tendon injury.

Runners and people who participate in athletic pursuits involving high-speed footwork most often sustain these injuries. However, something as simple as tripping or taking a misstep while walking or hiking can lead to a muscle or tendon injury. Your risk for an upper calf strain increases as you age, according to an August 2017 British Journal of Sports Medicine review article.

Sudden pain in the upper calf can signal a condition called deep vein thrombosis (DVT), which refers to the spontaneous formation of a blood clot in a deep vein of the body. These clots most often form in a deep calf vein and can extend upward to involve the area behind the knee, the thigh, the hip area or beyond.

DVT involving the calf or knee region commonly causes sudden development of one-sided aching pain in the area often accompanied by swelling, tenderness, redness, skin warmth and possibly a firm, cord-like lump.

A DVT clot can potentially break loose, travel to the lungs, and cause a serious complication called a pulmonary embolism. Some common risk factors for lower leg DVT include major surgery, pregnancy, and immobility due to surgery, illness, or a long flight or car ride.

Spinal nerves transmit signals that stimulate muscle movement and enable your perception of sensations, including pain. These nerves arise in your spinal cord and divide into smaller branches as they travel to different body sites.

Pressure on the nerves that tranmit signals to and from the upper calf area can trigger pain and other abnormal sensations, such as tingling, burning or prickliness. This compression can occur anywhere along the path of the nerves that supply the area, such as near the origin of a spinal nerve or behind the knee.

Examples of causes of nerve compression leading to upper calf pain include a herniated disc, a soft tissue growth, or inflammation of the structures at the back of the knee.

Other less common conditions can also potentially cause pain at the top of your calf. Examples include:

• Popliteal cyst (also known as a Baker cyst) - a noncancerous, fluid-filled growth
• Posterior cruciate ligament sprain - tear in one of the ligaments that stabilizes the knee joint
• Meniscus injury - tear or damage to cartilage cushions in the knee joint
• Compression or blockage of arteries that supply blood to the calf muscles

See your doctor as soon as possible if you experience sudden, severe, worsening, or persistent upper calf pain, or if you sustain an injury that interferes with your ability to walk.

Seek immediate medical care if you experience any warning signs or symptoms that could indicate a potentially life-threatening problem, including:

• Shortness of breath or difficulty breathing
  
• Chest pain
• Sudden development of a cough
• Dizziness, lightheadedness, or fainting

Reviewed and revised by: Tina M. St. John, M.D.