Calf pain can be annoying, but it’s rarely a cause for serious medical concern. The wrong shoes, a muscle cramp, stress, dehydration, remaining in the same position for an extended period, and minor injuries can all lead to aching calves.
But when calf pain is intense, gets worse over time, or distracts you from everyday duties, it could signal a more serious problem. Every year, as many as 900,000 people experience blood clots in a vein or artery. Most of these blood clots occur in blood vessels in the legs, where decreased circulation is common, and when this occurs in a deep vein in the leg, it is known as deep vein thrombosis (DVT). The blood clot itself is never fatal, but if it breaks free, it can travel to your brain, heart, or lungs, and can trigger a deadly cardiovascular episode.
So how can you tell the difference between a muscle cramp and a blood clot? And how do you know if you're at risk? Only a doctor can say for sure, but knowing what to look for can help you detect a blood clot before it endangers your health.
Who is at Risk for Blood Clots?
Anyone can experience a blood clot, but they most likely occur when something interferes with circulation to your lower extremities. You're at the most risk if:
Dr. Elias says in order to avoid blood clots, it’s important for people to try “to minimize the risk factors such as immobility, dehydration when traveling, sedentary lifestyle.“
Common Symptoms of Blood Clots
The most common symptom of a blood clot is leg pain that can't be explained by something else, such as a bruise or recent injury. The pain will be concentrated in one area, not shooting from one spot to another. If pain lasts for more than a few days or is intense, it's time to be checked out by a doctor. Sometimes the pain accompanies other symptoms, including:
Blood Clot or Calf Pain?
“At times the difference between leg cramps or blood clots is very hard to determine,” said Dr. Elias. “But the history is very important.”
To help determine whether the source of your leg pain is a blood clot or something else, you need to tell your doctor what you’ve been doing over the last few days.
“If a patient has been on a long air flight or car ride and then has pain afterward this would more likely be due to a blood clot,” said Dr. Elias “But if the patient did a lot of exercise for a day or two before and wakes up with sore crampy legs this of course would be more likely muscle cramps.”
If basing a diagnosis solely on history and examination, even an experienced vein specialist would only be right 50% of the time.
“This is why we almost always get an ultrasound if we suspect a blood clot at all,” Dr. Elias said.
Imaging techniques such as an ultrasound, MRI or venogram of your legs can tell you for sure whether the pain is due to a muscle injury or blood clot, so consult your doctor if you are worried you might have a blood clot. It is possible even if you do not have the telltale risk factors.
Some common differences between calf pain and blood clots include:
Going to the Emergency Room: Better Safe Than Sorry
If you have some unexplained calf pain without major signs pointing to a blood clot, it's usually fine to wait until the next day to see your doctor if the pain doesn’t subside. However, you should definitely go to the emergency room if you experience “a sudden onset in lower leg pain mostly calf or sudden swelling without any trauma,” said Dr. Elias. You should also go to the emergency room if you have had recent surgery and have not been walking much, and then experience unilateral leg swelling, according to Dr. Elias.
Additionally, if you have multiple risk factors for a blood clot — particularly recent lengthy travel where you couldn't stretch your legs, or if you are on bed rest — treat the pain as a medical emergency and go to the emergency room. You might be embarrassed if it turns out to be nothing, but if you have a blood clot, acting fast could save your life.
Most calf pain will go away on its own, so there’s no need to panic with each ache you experience in your calf. But calf pain should be taken seriously if it is intense and does not go away. Blood clots are highly treatable, so a simple consultation with your doctor could save your life.
Expert Venous Management will be of value to vascular surgeons, interventional radiologists, interventional cardiologists, cardiologists, phlebologists, general surgeons and other medical professionals currently treating venous disease and want to advance to the next level.
This course takes venous education to the next level.
Limited to 75 participants.
Basic knowledge of venous disease required.
Attendees will learn the advanced management of venous disease
Attendees submit cases prior to course and best ones are selected by faculty to discuss.
Attendees are active participants.
Small Faculty-Attendee Ratio = Lots of faculty interaction
Steve Elias - Englewood Hospital and Medical Center
Antonios Gasparis - Stony Brook Medicine
Nicos Labropoulos - Stony Brook Medicine
Kush Desai - Northwestern University
Ellen Dillavou - Duke University
Bill Marston - University of North Carolina
Mark Meissner - University of Washington
Peter Pappas - Center for Vein Restoration
The registration fee covers admission to the scientific sessions, course materials, welcome reception, continental breakfast, refreshment breaks and lunch.
Two ways to register:
1. Call 732-678-6038 with credit card info
2. Pay online through PayPal at
The course will be held at Englewood Hospital Medical Center
350 Engle Street - Englewood, NJ 07361
145 Dean Drive
Tenafly NJ 07670
Steve Elias, MD, is the director of the Center for Vein Disease at Englewood Health. Board certified in general surgery and venous and lymphatic medicine with expertise in blood clots/DVT, leg ulcers and varicose and spider veins, Dr. Elias sat down with us to answer some questions about our veins. Steve Elias, MD, is the director of the Center for Vein Disease at Englewood Health. (Photo: Center for Vein Disease at Englewood Health)
What causes varicose veins?
Veins, which bring oxygen-depleted blood back to the heart, have one-way valves (check valves) that keep blood flowing back up the legs toward the heart. When the valves fail, the blood leaks back down the legs and pools. This puts pressure on your veins, and over time they can weaken and bulge. In the legs, for example, this can result in visible varicose veins and significant symptoms or complications such as blood clots or ulcers.
Aren’t varicose veins simply a cosmetic issue?
Most varicose veins are not cosmetic. Although vein disease is rarely a life- or leg-threatening problem, symptoms — heaviness, aching, swelling, throbbing and itching — can impact your quality of life and affect your ability to function normally. Varicose veins can cause complications including blood clots, phlebitis (an inflammation of the veins) or ulcers (sores) that are not healing because of the vein disease. Most varicose veins are treated for symptoms or complications, which are usually covered by insurance. Some people don’t have symptoms; for them treatment would be cosmetic.
Can you be affected by varicose veins and not even know it?
Your legs might feel tired, aching or heavy as the day progresses and you might just attribute it to getting older. Often you don’t make the connection between the symptoms and vein disease. Also, you may have ulcers or wounds near your ankles, which can be caused by abnormally functioning veins. Finally, swelling of one leg with or without a history of blood clots can be due to narrowed or blocked veins.
Why do my legs feel good in the morning and bad in the evening?
At night while you are sleeping your legs are elevated and gravity is helping to drain the veins of extra blood that accumulated during the day. If you have poorly functioning veins, the more you are on your feet or sit at work the more you will feel the symptoms. Symptoms tend to get worse as the day progresses. At the end of the day you are carrying around more blood in your leg veins than when you woke up. It’s rarely a pain. It’s more of a tired, heavy, achy feeling. If symptoms are affecting your quality of life on a daily basis they should be treated.
Can vein disease be prevented?
Living a healthy lifestyle always helps overall health. Unfortunately, there’s not much you can do to reduce the risk of developing varicose veins because the causes are primarily genetic.
How do I know if I have a blood clot?
Many times, you won’t realize you have a clot. If you have any concerns or risk factors (like family history), be aware if one leg seems heavy, tired or swollen after sitting in a car or plane for a long time. Your calf may become tender. Being in a hospital bed for a long period of time or being in a leg cast can also increase your chances of developing a clot.
What are the main risk factors for varicose veins?
Minimally invasive technologies for treating vein disease really came into play in the early 2000s and the technologies get better each year. For almost any vein procedure you have at Englewood Health, there will be no cuts, no stitches, just a few needle sticks and local anesthesia, and the whole procedure will take about 30 minutes. Most patients walk in and walk out and are back to just about anything they want to do the next day or two. There are a few vein procedures that may require two or three very small (3mm) incisions.
Why choose the Center for Vein Disease at Englewood Health?
Englewood Health has a dedicated vein center, located at Englewood Hospital, led by a board-certified vein specialist. We are a high-volume center with highly experienced physicians, offering the full range of the newest treatment options before most other providers can offer them.
Our patients have access to our clinical trials, including participation in industry trials. This means our patients can get the newest technologies sooner, with a surgeon who is highly experienced in using a range of treatments.
We provide tailored care for the individual patient’s need with the best technology for them because all current minimally invasive technologies are offered.
In addition, we train physicians — from around the country and the world — who come to learn the newest techniques at Englewood Hospital.
What’s the most important thing you want people to know?
All veins can be treated. Some technologies are better for curvy, straight, small or big veins. At Englewood Hospital, with these technologies we can treat nearly every single vein in the body. Even if a person has had blood clots (and scarring from those clots) or ulcers that keep coming back, we can treat these affected veins with minimally invasive tools to alleviate symptoms and prevent recurrence. People tend to accommodate and live with symptoms. However, once they are treated, most patients find they feel that the leg is lighter with more energy.
If you have your veins treated for the right reasons, by the right doctor using the right technologies at a facility such as the Center for Vein Disease at Englewood Health, you are likely to have a significant improvement in symptoms and appearance and prevent further complications from vein disease.
Members of the editorial and news staff of the USA Today Network were not involved in the creation of this content.
A panel discusses how they navigate the technologies available for treating superficial venous disease and the factors that influence widespread adoption.
With Steve Elias, MD, FACS, FACPh
Long question, short answer: “Sooner or later it all comes down to money” as sung by Bruce Springsteen in “The Big Muddy.” This answer may seem cynical or simplistic, but most physicians don’t adopt a new platform or technology unless there is something in it for them—intellectual stimulation, notoriety, novelty, or remuneration. Most people don’t work at their job without compensation. We have seen this movie before many times. In fact, in superficial vein care, we are now realizing the algorithm of care that answers the question, “What forces most drive platform adoption in superficial vein care?” is often, “Because I can get paid.” Money talks and now some vein specialists are doing too many procedures because they can get paid. This is an issue that has been discussed in this publication and others, as well as at societal meetings. We are working on solutions. Another topic for another day.
Currently, we have reimbursed platforms that are safe, efficacious, durable, and relatively patient friendly for treating superficial venous disease. One need not feel as if they are providing inferior or substandard care to most patients most of the time with currently covered and available platforms. Yet, there are new nonreimbursed technology platforms that have some inherent advantages to patients and physicians. Some people are using them. The why and how may help answer the posed question.
We can divide physicians, and specifically surgeons and proceduralists, into three categories: (1) early adopters, (2) secondary adopters, and (3) reluctant adopters. Most proceduralists are not driven to change as long as what they are using seems to be working for them and for their patients. Most are not comfortable with feeling uncomfortable, except the early adopters. Most will adopt new platforms only if they need to or if they get paid. Yet, there are early adopters who simply embrace the new. These are the ones involved in clinical trials and platform development so that they can gain experience for their patients and themselves. They are the first wave. Reimbursement may not be an issue because their experience and their patients’ experience are gained by clinical trial support. However, these cases are the minority.
The great majority of physicians are secondary adopters. They wait for data, demand, and reimbursement. This is what drives their adoption. They wait and they wait, but their patience usually pays off for their patients and themselves. Their patients get treated with procedures, technologies, or platforms that are proven and reimbursed. Although this approach may not be as interesting or stimulating as the early adopters’ approach, it is the standard safe approach that is time-proven.
Luckily, reluctant adopters are the minority. By the time the reluctant adopters consider using new platforms, most of them have been vetted by research, time, and results. The losers of the reluctant adopter approach are both patients and physicians. The patients more than physicians because good care and new platform technology has been withheld longer by these physicians for their patients than most other patients.
It is the nature of medicine and surgery to progress and change. We all want to improve patient care. It is also the nature of new platforms to take time for data, results, and reimbursement to accumulate. There is at least a 3-year lag time from market entry to successful reimbursement for most platforms. Forces driving platform adoption are linear. Who adopts and at what point along the line of the “adoptive path” depends on the “adoptive attitude” of each individual practitioner. Some are early adopters, most are secondary adopters, and a few are reluctant adopters. But in reality, for most, the forces that drive platform adoption is the Jerry Maguire mantra, “Show me the money.” Not cynical or simplistic, merely realistic.
March is national Blood Clot Awareness Month known as Deep-Vein Thrombosis (DVT), a public health initiative aimed at raising awareness of this commonly occurring medical condition and its potentially fatal complication, pulmonary embolism. According to the American Heart Association, up to 2 million Americans are affected annually by DVT, more commonly known as blood clots. Yet, most Americans (74 percent) have little or no awareness of DVT, according to a national survey sponsored by the American Public Health Association.
Dr. Steve Elias Director of The Vein Center at Englewood Medical Center has written a few examples below of what people should look for if they think they may have a blood clot or DVT.
Even though he was wearing a helmet when riding his motorcycle, in the Emergency Room the CT scan of Dick’s head showed some bleeding around his brain. He was a safe driver and was coming home from work when he was hit from behind while stopped at a light. After brain surgery to remove the blood, Dick was in the hospital bed recovering and not moving around that much. Ten years later he is doing fine but his left leg swells as the day progresses.
He wears compression stockings that help a little bit. John has chronic DVT commonly known as blood clots.
Jane was always an athlete. Running was her main activity but in her 50’s Jane’s left knee was painful during and after running. After much physical therapy and medication, Jane had a knee replacement. Three years later she is back competing in triathlons. Her left leg is always more swollen than the right. It feels heavy and throbs by the end of the day. Jane has chronic blood clots.
What happened to Dick and Jane? What is their problem? Can they be helped? March is National DVT Awareness Month. Dick and Jane both had a blood clot in the past that was unrecognized and untreated. They now have symptoms due to the clot and the damage that occurred to their veins. People get blood clots for many reasons: immobility from accidents or surgery, inherited clotting disorders, hormone therapy, long air or car travel, etc. Usually a blood clot is diagnosed early and it is treated with blood thinners. Usually the blood clots don’t damage the veins but sometimes the veins develop scarring and narrowing and don’t work correctly. This is what happened to Dick and Jane.
The veins bring the blood back to the heart. When we walk the muscles in our legs pump the blood up the veins back in the direction of the heart. If the veins are scarred and narrowed (blocked), the blood can’t flow back as quickly as it should. Blood backs up and patients experience symptoms of: swelling, pain, pressure, throbbing in their legs. This is usually worse by the end of the day. Sometimes they even develop ulcers or skin discoloration around their ankles. Until recently patients were told that there really wasn’t much that could be done. All they could do was to wear compression stockings and elevate their legs. Now things are different. Now many times we can help by using procedures that stretch and widen the veins so that the blood can flow back to the heart more normally.
Angioplasty and stenting are what these procedures are called. Many of you may be familiar with the terms from treating blockages in the blood vessels of the heart. Veins are different, they are bigger. They may get blocked by previous blood clots or phlebitis (inflammation). Treating them is much less risky than treating the heart arteries. Once the diagnosis is made by either: ultrasound, MRI, CT scan or venography patients can have the narrowed parts of their veins made wider by stretching these areas with balloons (angioplasty) and then keeping them open by placing stents in the stretched veins. All of these procedures require no incisions or stitches, only a needle stick. Most patients return to normal activity in a day or so.
If you’ve had a blood clot, if you have a leg ulcer, if you have symptoms that affect your quality of life then you should seek out a vein specialist that can help you. The diagnosis is non-invasive and the treatments are minimally invasive. Not every patient is a candidate for these procedures but many are. It depends on each individual’s anatomy and level of vein damage. Most patients can be helped. If you’ve had a blood clot or know someone who does, take the responsibility during National DVT Awareness Month and share the information to get the help that is needed. Select a an experienced vein specialist and learn about the numerous non-invasive quick procedures to prevent blood clots. Dr. Steve Elias Director of Center for Vein Disease at Englewood Hospital and internationally recognized world leader in venous disease teaching doctors from all over the world, for an appointment or consult call 201.894.3252 or visit veindisease.com
Englewood Hospital’s Dr. Steve Elias Teaches
Doctors from Latin America How to Use the ClariVein Device
LATAM MEETING – Vascular Insights
Dr. Steve Elias recently was in Ft. Lauderdale Florida to teach 15 physicians from Latin America about the ClariVein device. This device had was first used in humans by Dr. Elias in 2009 at Englewood Hospital and Medical Center. Over the years many vein experts have visited Dr. Elias and he has traveled around the country and the world teaching. The physicians at the Florida meeting came from: Mexico, Brazil, Columbia, Chile and other countries. ClariVein is a device that treats varicose veins, a same day procedure, no incisions, using local anesthesia. It takes about 30 minutes to perform.
Do you have or have you had non-healing leg ulcers, varicose veins, or blood clots?
Englewood Hospital and Medical Center and Dr. Steve Elias are seeking participants to assess a treatment for the veins that cause leg ulcers.
You may qualify to participate in this FDA approved study.
Call (201) 608.2619 for more information or visit veindisease.com for details.