Sometimes I don’t know the answers to my patients’ questions.  Sometimes I don’t know exactly how to “fix” them.  There are few things that frustrate me more.  So when my patients ask me about nocturnal leg cramps I inwardly cringe, because I don’t always have a straightforward answer for why they get the cramps or how to treat them.  The truth is that the medical community at large has a poor understanding of this common ailment. 

     The International Classification of Sleep Disorders recognizes “sleep-related leg cramps” as a true sleep disorder.  These night cramps are sudden, painful, involuntary contractions of muscles in your calf, feet, or thighs.  The muscle that is cramping will feel hard and sometimes you can even see it tightening.  Some of my patients report that these severe cramps awaken them from sleep (talk about a rude awakening!) or prevent them from even falling asleep at night.  This can even lead to chronic sleep deprivation.   The incidence of night cramps has been shown to increase with age.  There is research that shows that half of people over the age of 80 reported having sleep-related cramps at least once in the past 2 months.  These types of leg cramps are also increased during pregnancy.

     While it is not known exactly what causes night cramps there are a lot of theories out there.  These theories usually point to metabolic disorders (such as magnesium, calcium, potassium deficiency, or dehydration), structural disorders (tight muscles, flat feet), positional (making a movement in your sleep that shortens the muscle), or over-exertional (fatigued muscles are more likely to cramp). 

    It is also important to rule out diabetes and peripheral vascular disease when searching for a reason for your cramping.  While both of these conditions can cause discomfort in the feet and legs at night, neither one of them causes muscles to spasm or become tight and hard.  The same goes for restless legs syndrome, which is associated with an uncomfortable urge to move the legs, not necessarily pain. 

    Treatment of night cramps is pretty easy.  It usually just involves slow and steady stretching or massaging of the cramping muscle.  A heating pad or hot compress can also aid in muscle relaxation.  Some people recommend taking a vitamin supplement or drinking water to stop the cramp, but the truth is that the cramp will be gone before either of these has time to take effect. 

    The best treatment for night cramps is prevention, which can be the tricky part since we really don’t know what causes them.  As a general rule, if there are lots and lots of treatments for one condition it usually means that no one treatment works really well for most people.  And there are a MULTITUDE of suggested treatments for preventing night cramps!  I have heard everything from drinking a glass of pickle juice to taking Quinine (which is not even available in the US because of the severe adverse effects).  

Some of the more common suggestions are:

•   Staying hydrated.  The sense of thirst diminishes with age, so a lot of older adults fail to adequately hydrate themselves.  A diuretic (“water pill”) can also potentiate dehydration.  Dehydration can lead to electrolyte imbalances that may cause cramping.  And sorry -alcohol and caffeinated beverages don’t count as adequate hydration!  In fact, they can make the problem worse.

• Maintaining adequate calcium and magnesium.  Both of these play a big role in muscle contraction.  What about potassium???  All of my patients seem to think that a banana a day will keep the cramps away.  While potassium deficiency can cause cramping, this is not common; it is more likely to cause muscle weakness.  Vitamin E is also a common treatment for cramps although studies about why and how it works are lacking. You should always consult with your primary care physician before starting supplemental calcium, magnesium, or potassium.

• Speaking of consulting with your physician, it is always a good idea to talk to your physician about whether a medication you are taking could be contributing to your cramping.  There are quite a few medications that do.  Medication-induced cramping does not usually occur exclusively at night though.

• Stretching before bed and before and after exercise.  This may be the most effective treatment for nocturnal leg and foot cramps.  A few minutes of light stretching before bed using a night splint, the wall, an exercise band, or towel can be helpful for relaxing the muscles.  Do not stretch too aggressively though as this could trigger cramps.

•  Proper supportive shoe gear and orthotics go a long way in preventing over fatigue of muscles in the feet and therefore can prevent cramps in the arch of the foot and toes, a common complaint of my patients.

If you are losing precious sleep because of cramping in your legs or feet it’s time to do something about it.  No one has all of the answers regarding night cramps, but at Advanced Foot and Ankle Care we are here for you to attempt to answer any of your questions regarding cramping in your legs or feet (at night and otherwise). We will work with you to assess the reason for the cramping and make suggestions for preventing the cramping whether it is giving you a night splint, showing you stretching exercises, giving advice on the proper shoes, or fitting you with orthotics.  You’ll be back to catching Zzzz’s before you know it!

Hillarie Amburgey, DPM