Lower Leg Injuries and Conditions

lower leg illustration

Lower leg injuries come in many forms. Forces from foot-strike radiate up the leg. Many of the foot and ankle muscles start in the lower leg. These injuries can be painful and difficult to diagnose and treat. With our expert team of Sports Medicine providers, we are able to diagnose and treat even the hardest problems.

The UConn Musculoskeletal Institute offers a comprehensive approach to lower leg problems – from diagnosis and treatment to rehabilitation and recovery, including fasciotomies and tendon repairs to state of the art Achilles tendon treatments. The staff includes licensed physical therapists who work closely with the physicians to provide the latest treatments for injuries. We have certified orthotists available if custom orthotics or braces are required.

Our Services

Our sports medicine team is able to care for all problems from stress fractures to tendon tears.

We have the capability to diagnose and treat all aspects of sports related lower leg injuries in athletes and dancers. This includes the fully trained support staff of our Sports Medicine program.

Common Lower Leg Problems

Compartment Syndrome

Chronic exertional compartment syndrome (CECS) is a condition that can occur from repetitive loading or exertional activities. CECS is usually observed in athletes; long-distance runners, basketball players, skiers, and soccer players. It can occur in any of the four lower leg compartments but the anterior compartment is the most common.

CECS is characterized by exercise-induced pain that is relieved by rest. In some cases, weakness and/or numbness occur as well with exercise. The onset of symptoms typically occurs at a specific exercise distance or time interval (e.g., within 15 minutes of initiating a run). Symptoms subside with rest and are minimal during normal daily activities but return when activity resumes.

The diagnosis of CECS is one of exclusion, based on the clinical history, the physical examination findings, and the exclusion of various differential diagnoses. Compartment pressure readings with and without exercise are the gold standard for the diagnosis of CECS.

Compartment pressure testing must be performed under sterile conditions. The needle tip location, the depth of penetration, and the knee and ankle position are controlled to obtain reliable measurements. The anterior, lateral, and superficial posterior compartments are relatively easy to test; testing the deep posterior compartment is more difficult. Complications from testing, though low, include bleeding, nerve injury, acute compartment syndrome, and infection.

Our method of testing is to measure the resting compartment pressure, exercise the patient until a symptomatic level is reached, and then measure again, at one minute and five minutes post-exercise.

The criteria for the diagnosis of CECS in the leg is one or more of the following:

  • A pre-exercise/rest pressure of 15 mm Hg or higher
  • A one minute post-exercise pressure of 30 mm Hg or higher
  • A five minute post-exercise pressure of 20 mm Hg or higher

Although the diagnosis of CECS can be made if just one of the above criteria is met, the greater the number of criteria that are satisfied, the greater the confidence level of the diagnosis.

Stress Fracture

A stress fracture of the lower leg is an overuse injury. It can be difficult to diagnose due to vague discomfort and generalized pain over the muscles of the lower leg and are often misdiagnosed as shin splints. They come on slowly over time from repetitive trauma to the muscles and bones, often due to overuse. They occurs when muscles become fatigued or overloaded and cannot absorb the stress or shock of repeated impacts and start to break. Fatigued lower leg muscles transfer that stress to the nearby bone and the result is a small crack or fracture in the bones of the lower leg often not seen on plain radiographs (x-rays).

Medial Tibial Stress Syndrome (Shin Splints)

Medial tibial stress syndrome (MTSS) or shin splints is a common injury that affects athletes who engage in running. This condition is characterized by pain in the lower part of the leg between the knee and the ankle. MTSS is caused by repeated trauma to the connective muscle tissue surrounding the tibia (shinbone). Ignoring this injury may result in a more serious condition such as a stress fracture of the bones.


Periostitis is a condition caused by inflammation of the periosteum, a layer of connective tissue that surrounds bone. The condition is generally chronic and needs to be differentiated from stress fracture or shin splints, and is marked by tenderness and swelling of the bone and an aching pain. Correcting underlying hip weakness, running mechanics, improper shoes, and other problems can correct this problem.

Popliteal Artery Entrapment Syndrome

Popliteal artery entrapment syndrome (PAES) occurs due to an abnormal positioning of the popliteal artery in relation to its surrounding structures. These abnormal positioning can produce extrinsic compression of the popliteal artery and cause vascular damage. Diagnostic delay is common because this problem usually occurs in younger patients, and mimic stress fractures and compartment. Most commonly, PAES is found in young athletes with well-developed muscles, because the exercise and enlargement of muscles adjacent to the popliteal artery exacerbates the consequences of the anomalous relationship between muscle and artery.

Mitochondrial Myopathy

Mitochondria are responsible for producing most of the energy that’s needed for our cells to function. A mitochondrial disease can shut down some or all the mitochondria, cutting off this essential energy supply. The exact symptoms aren’t the same for everyone, because a person with mitochondrial disease can have a unique mixture of healthy and defective mitochondria, with a unique distribution in the body. Because muscle cells and nerve cells have especially high energy needs, muscular and neurological problems — such as muscle weakness, exercise intolerance, trouble with balance and coordination — are common features of mitochondrial disease. A mitochondrial disease that causes prominent muscular problems is called a mitochondrial myopathy (myo means muscle, and pathos means disease). Despite their many potential effects, mitochondrial diseases sometimes cause little disability. Sometimes, a person has enough healthy mitochondria to compensate for the defective ones, so exercise is the only time symptoms are present.

Muscle Cramps (Night Cramps)

A muscle cramp is a sudden and involuntary contraction of one or more of your muscles. They can cause excruciating pain. Often harmless, muscle cramps can make it temporarily impossible to use the affected muscle. Long periods of exercise, particularly in hot weather, may lead to muscle cramps. Some medications and certain medical conditions also may cause muscle cramps.

Achilles Tendonopathy

Achilles tendonopathy is pain in the lower leg along the tendon behind the ankle caused by overuse. It can lead to thickening of the tendon from improper healing. The pain is slow in onset and eventually will be too painful to exercise and can cause the tendon to rupture.

There are many new and exciting treatments to fix this problem.

Calf Muscle Tear

Calf muscle tears is a sudden pain that occurs in the calf muscle during activity which causes injury to the muscle. This injury is called a calf strain. It occurs when part of the muscles of the calf (gastrocnemius or soleus) are stretched beyond their ability to withstand the tension and tear. This stretching can result in small microtears to the muscle fibers or, a more severe injury, a complete rupture of the muscle fibers.

Plantaris Tear

Although the plantaris has little importance in the lower leg, there are injuries that can occur, which can cause disability and pain. Tennis leg is a common name for the injury. It is a result of an eccentric load placed on the ankle while the knee is extended, and occurs while running, cutting or jumping. It may be caused by direct trauma to the calf area. Pain and swelling are common in the injury.

Achilles Tear

Achilles tendon rupture is a common injury that can cause severe disability. It is often missed in the emergency room due to the swelling. It happens frequently pushing off to cut in the opposite direction in tennis or basketball, but it can happen in any sport with change of directions like soccer or lacrosse. Tendonopathy can predispose people to tears. It happens more often in 30 and 40 year old athletes but can happen at any age after puberty. Treatment can be surgical or non-surgical but it is important to get treatment early.