Editors

EBMG

Calf Pain

Diagnose acute arterial occlusion, deep venous thrombosis and erysipelas immediately.
Recognize critical ischaemia and refer the patient urgently.
Recognize compartment syndrome and stress fracture (which are particularly common in military conscripts and athletes).

Symptom or sign	Diagnostic clue
Calf or ankle oedema Leg Oedema	Deep venous thrombosis Deep Vein Thrombosis Insufficient valves in deep veins (stasis eczema; Venous Insufficiency of the Lower Limbs) Ruptured Baker's cyst (history of a mass in the popliteal fossa; Baker's Cyst)
Erythema of the skin	Erysipelas Erysipelas
Local pain in the skin	Superficial thrombophlebitis Superficial Venous Thrombophlebitis
Intermittent claudication	Lower limb ischaemia Lower Limb Ischaemia (weak or absent pulses; lowered ankle-brachial index on Doppler ultrasonography) Spinal stenosis Lumbar Spinal Stenosis (LSS)
Back pain exacerbated by bending forwards	Sciatica Low Back Pain; pain often felt also elsewhere than in the calf
Pain felt near the heel	Achilles tendon injury Achilles Tendinopathy and Tendon Rupture
Military conscripts or athletes	Stress fracture (local tenderness on the tibia; Stress Fractures) Compartment syndrome Muscle Compartment Syndromes
Sudden onset	Muscle injury Muscle Injuries Ruptured Baker's cyst Arterial embolism (coldness, pulselessness, paleness; Lower Limb Ischaemia)

Localize the pain by history, palpation, and straight leg raising test.
Recognize pitting oedema of the ankle by pressing with a finger for long enough.
Palpate the peripheral pulses (only a strong pulse is definitely normal)
Examine the arteries (and veins) with a doppler stethoscope if available Doppler Stethoscopy in Diagnostics.
Deep vein thrombosis can be excluded in low-risk patients with D-dimer test in primary health care Deep Vein Thrombosis.