Foot Cramps – Causes & How to Get Rid of Them
A knotting sensation in a foot that no one wants to experience.
This sensation result in curling of toes or a painful spasm in the arch of the foot is usually a sign of cramps.
The symptoms often manifest at night and might lead to disturbed sleep and intense spasm-like pain.
But how does these cramps occurs?
Answer can be found in the movement of foot muscles. They work in pairs of agonist and antagonist. Cramps develop when the antagonist muscle fails to relax following contraction of the agonist muscle.
Foot cramps can last for a few seconds or could continue for a few minutes. The discomfort associated with muscle spasms can make a person difficult to use the muscle temporarily.
Usually, foot cramps are idiopathic but can also be a result of other medical conditions.
The most common cause is a mineral deficiency, which can be remedied by ensuring a nutritional diet rich in minerals and vitamins.
A study estimates that nocturnal leg cramps affect up to 33% of the population over the age of 50. The symptoms and the occurrence of such cramps increase with age.
Aother study suggests that cramps can last nine minutes per episode, on average. The residual pain could last for a few hours. There could also be recurrent episodes in a day.
Foot cramps are usually not a serious ailment and can be treated with self-care. However, nocturnal foot cramps also pose as symptoms of cardiovascular and renal diseases, Parkinson’s disease or cirrhosis.
It is imperative to ensure that an underlying medical condition is not causing the cramps. (1)
What Causes Foot Cramps?
The cause of foot cramps can be categorized into idiopathic and secondary, which is a result of a medical condition.
Foot cramps can be a result of the following conditions or a combination of them.
Counting calorie intake has become the newest trend to lose weight. However, a diet of empty calories lacking nutritional value can have damaging effects on the body.
Deficiency of sodium, magnesium, potassium, calcium and/or Vitamins B and D could lead to painful leg cramps.
The food we eat is the only source of vitamins for the body, as these organic compounds cannot be manufactured by the body.
Potassium is an electrolyte, which carries electrical impulses to enable muscle control. The mineral ensures the ability of skeletal and smooth muscles to contract.
An extremely low potassium level leads to foot cramps. However, excessive potassium intake in case of damaged kidneys could cause irregular heartbeat. Therefore, intake of potassium should be monitored for renal disease sufferers.
Magnesium is an important mineral and is necessary for over 350 biochemical reactions in the body. Adenosine tri-phosphate (ATP), which is the fundamental unit of energy within the body’s cells, exists typically as MgATP in the body. ATP is the driving fuel for functions such as muscle fiber contraction.
Severely low magnesium levels could also result in muscle wastage. The initial symptoms of low magnesium include muscle cramps or spasms. (2)
It is crucial to maintain the balance between calcium and magnesium in the body. The body tends to perceive the level of one nutrient as low if the other is high. Cramps caused by calcium deficiency are usually a result of calcium displacement rather than the lack of calcium in the body.
Soft tissue calcium starvation cramps can be prevented by ensuring calcium intake in the form of calcium lactate or citrate and maintaining a proper fatty acid balance. (3)
Supplementary intake of the water-soluble Vitamin B has also been known to treat foot cramps.
Motor nerves pass information from the brain and spinal cord to the muscles to control movement.
A damage to these nerves causes motor neuropathy. Symptoms include muscle cramps and twitching.
The National Institute of Neurological Disorders and Stroke estimates 20 million people in the US suffering from peripheral nerve damage. (4)
Muscle cramps are commonly caused by benign leg cramps and exercise-associated cramps.
Sufferers should consult a physician if motor neuropathy is accompanied by vomiting, diarrhea, weight gain or menstrual irregularities.
If the body loses more fluids than it intakes, it causes dehydration. This is noticed when cramps occur during exercising on a hot day.
The heat effect on the muscles makes it seize up as they work harder and harder with exercise.
However, the same effects can be noticed irrespective of the outside temperature.
Cramps can also be noticed shortly after dialysis, as the procedure could remove too much fluid from the body and lower electrolyte levels.
The lack of sufficient thyroid hormone leads to Hypothyroidism. Muscle cramps and frequent muscle aches are some of the symptoms of this condition.
Autoimmune thyroiditis is an inflammation of the thyroid gland caused by a sufferer’s own body. This condition can also be a result of a surgical removal of a portion or all of the thyroid gland.
The severity and the duration of hypothyroidism decide the complexity of symptoms. In rare cases when left untreated, the symptoms can include heart-failure and life-threatening depression.
A prompt treatment is advised for people diagnosed with hypothyroidism. The condition can be diagnosed by a simple blood test.
Anemia is caused when the red blood cells or the amount of hemoglobin carried by them is low.
This condition results in an inadequate supply of oxygen carried by the blood resulting in symptoms such as fatigue, paleness and painful leg cramps.
Anemia can be caused by vitamin B12 deficiency, with the most symptom being a burning or prickling sensation in feet or hands.
Anemia caused by vitamin B12 deficiency might affect mental function.
Therefore, it is commonly mistaken for dementia in old people. A blood test to detect hematocrit can be used as a diagnosis of anemia.
Diabetes sufferers often complain of diabetic peripheral neuropathy. This results in painful foot cramps.
The symptoms can be managed by maintaining proper glucose levels in the body.
Other diseases such as Parkinson’s and Huntington’s Disease can also cause foot cramps.
Diuretics are commonly prescribed for high blood pressure. The drugs get rid of excess fluid from the body by moving it into the urine.
In this mechanism, the excretion of electrolytes such as potassium, chlorine, and sodium is increased. As mentioned earlier, the low level of such electrolytes leads to muscle weakness and foot cramps.
Beta-blockers, which are used to treat migraines, arrhythmias, high blood pressure and some forms of glaucoma, block the effects of the adrenaline hormone.
This results in slowing the heart rate. Research has found the narrowing of arteries in the legs and arms with beta-blockers.
However, there can be a delay in noticing foot cramps as symptoms post the onset of the treatment. The symptoms can start appearing after a few months or after two years. This delay makes it difficult to connect the foot cramps with the beta blockers.
Statins and fibrates such as fenofibrate, simvastatin, and atorvastatin are usually prescribed for treating high cholesterol. However, these medicines can cause muscle weakness by breaking down skeletal muscle. (4)
Nocturnal Leg Cramps
A study reveals around 7% children and adolescents suffer from nocturnal leg cramps. In the general population, 40% of those aged over 50 have been affected by it.
However, as these cramps are normally not brought to a physician’s notice, it is safe to say that the number could be quite higher.
Although, the incidents have a tendency to increase with age.
Nocturnal leg cramps can affect the small muscles of the foot and other parts of the leg. Such cramps are not associated with low electrolyte levels and dehydration.
In the nocturnal rest position, the calf muscle fibers are already maximally shortened as the foot is passively in plantar flexion. The position can be described as sleeping with knees bent and feet pointing down.
Cramping is, therefore, a result of uninhibited nerve stimulation caused by decreased circulation from staying in one position for a long time. (5,6)
In some cases, night leg cramps can also result from spinal stenosis and peripheral artery disease.
A reduced oxygen level is connected to the rate of muscle fatigue. This condition is known as hypoxemia.
It can be a result of strenuous exercise, as tissues need more oxygen during exercise.
When the body does not receive enough oxygen they produce it themselves by breaking down glucose for energy. This anaerobic metabolism mechanism leads to the production of lactic acid and induces cramps. The lactic acid build-up in the bloodstream is at a fast rate.
Energy can be produced by the body anaerobically for up to three minutes, with the level of lactic acid increasing in the body and resulting in a burning sensation in this time. Post the three minutes, the muscles start slowing down. This serves as the body’s warning to stop the activity to prevent injury and fatigue.
Stiffness and joint pain are also the symptoms of oxygen deprivation in muscles.
Reduce the probability of lactic-acid induced cramps by pacing yourself between exercises. Start an exercise routine by aerobic techniques such as fast walking or running.
Hydrating the body also helps in getting rid of excess acid. Medical attention is recommended if cramps and pain continue after stopping the exercise.
Lactic acidosis can also be a result of medical conditions such as seizures, cancer, liver failure, sepsis and Vitamin B deficiency. Certain drugs used in the treatment of HIV and diabetes can also cause lactic acid-induced cramps.
The inflammation of the plantar fascia tissue in the foot can lead to foot cramps. The plantar fascia connects the heel bone to the toes.
Tightness under the foot can be a result of poor alignment, ligament strains and direct trauma. The tissue is essential for absorption of force to and from the body.
The inflammation can also be a result of prolonged walking or standing.
Tight foot arch symptoms are usually noticed in the morning as the tissue becomes constricted while sleeping. The pain can be reduced by performing stretching exercises to relax the tissue.
Physiotherapy can eliminate or reduce the pain in a few weeks. (7)
Foot cramps can also be caused by other factors such as:
Injury – Muscle cramps are usually noticed if there is a damage to the foot muscles. The overstretched or torn muscle result in cramps, which actually serve as a protective mechanism from further damage.
Such injuries are common in runners and sport-related activities. It has also been noticed in activities involving jumping, for e.g., basketball players.
Pregnancy – Foot cramps are noticed as the uterus expands. This results in stretching of the ligaments and muscles supporting the uterus. Foot cramps at night are common in the third trimester.
Ill-fitting shoes – Wearing tight fitting shoes squash the feet causing toe cramps
Treatment of Foot Cramps
The first course of action for leg cramps is self-care.
However, it is essential to consult a physician to know if there are any underlying conditions causing the cramps.
As foot cramps are common during pregnancy, utmost care needs to be undertaken while considering these self-care techniques.
Foot cramps can affect the toes and arch of feet. Gentle stretching of the toes and the feet can help relieve the spasms. Putting pressure on the feet and walking slowly causes the muscles of the leg to stretch.
Stretching exercises such as moving the leg up to the chest and then away from it can also help the muscles to relax.
Nocturnal leg cramps can also be relieved by these exercises, however, start with slow stretching. As the body is in a rest state during sleeping, vigorous feet movements could do more harm than good.
With hands on the wall for support, stand straight and raise your heels slowly. Hold this position for a few seconds and repeat to feel a slight stretch in the muscles.
While sitting down, cross one knee over the other and stretch the toes towards the shin. Repeat with the other knee.
Roll & Stretch
Rest the foot on a cold water bottle or a tennis ball while sitting. Roll the foot backward and forwards to stretch the soft tissues underneath the foot.
These exercises are helpful if the pain in the muscle is caused by cramps. However, a damage to the muscle cannot be treated with such exercises. Further injury can be caused by stretching damaged muscles.
A warm water bath can improve circulation and relieve cramps and the lingering pain.
Soaking feet in warm water or using a hot water for the affected area are known to provide relief.
Cold water can also help relax the muscles of the leg. A study suggests cold water immersion to have a positive impact on body fatigue in athletes.
Avoid dehydration by refueling the body with water intake. Exercising in hot water can lead to loss of electrolytes in the form of sweat. Stay hydrated to reduce the possibility of cramps
A diet rich in minerals and vitamins can help prevent foot cramps.
Maintain a proper level of electrolytes and minerals by including the following in your diet.
Source of Magnesium - Kidney beans, leafy vegetables such as spinach, seeds such as pumpkin and sunflower seeds, and whole grain.
Source of Potassium - Bananas, nuts and tomatoes
Source of Vitamin B - Peas, cereals, poultry, fish and egg products
Source of Sodium - Naturally present in milk, beets and celery.
Essential fatty acids are necessary for the body to break down glucose and reduce the risk of lactic-acid induced cramps.
Walnuts and flaxseeds are a good source of essential fatty acids. It can also be found in plant oils such as sunflower oil and cold water fish such as mackerel and tuna.
Symptoms associated with a poor diet can be relieved in a few days.
If cramps are noticed after wearing a certain footwear, it might be necessary to change the shoes.
Heels can often lead to cramps in the arch of the foot. Shoes with a wider toe box could help prevent cramps in the toes.
However, it is important to choose an exercise plan according to your fitness level as a vigorous exercise routine with improper equipment could cause injury.
Cramping can also be noticed when exercising on cardio equipment such as the Elliptical.
Leaning the body weight on your arms and shifting the feet can help relieve the knotting sensation in the foot. (8)
Acupressure – Alleviate foot cramps by pressing the top of the foot between the big toe and the second toe. A firm press should be maintained for a minute. (9)
Herbs – Foot cramps at night can be relieved by cramp bark, which is known to contain a muscle relaxant.
The valerianic acid in the herb can offer relief from cramps. Chamomile tea can also reduce cramps as it increases the amount of glycine in the body. (9)
Other herbs with cramp relieving properties include anise, garlic and fennel.
Epsom Salt – A bath with the magnesium-rich Epsom salt helps relieve tense muscles by soothing it. Additional benefits also include reducing stress and detoxifying the body.
Essential Oils – Peppermint or lavender oil can be used to gently massage the foot to relieve foot muscle tightness.
Breathing Exercise – Certain studies have found that breathing exercises (Pranayama) help relieve the painful sensation associated with cramps.
These home remedies are usually able to relieve the knotting sensation and pain and help relieve the discomfort.
The lingering pain from the cramp can sometimes be quite severe. Non-steroidal anti-inflammatory drugs can be used to relieve the residual pain.
However, other medications such Quinine sulphate should be introduced post consultation with a physician. Although it is known to treat nocturnal cramps, serious side effects have been indicated by the FDA in 2010. (10) Over-dosage of quinine is toxic and can result in accidental fatalities. (11)
Consult a physician if the muscles feel weak or the legs are swollen or change color.
Medical intervention is also needed for cramps are caused by nerve damage or medications. It is not recommended to use home remedies to treat such cramps.
Underlying conditions can be indicated by blood tests to identify cholesterol levels for cardiovascular disease, liver enzyme levels for cirrhosis and vitamin B12 levels for related neuropathy.
Cramps are common leg disturbances resulting in spasms and lingering pain. Foot cramps at night could cause sleep deprivation leading to disorientation and stress.
Some people suffer from foot cramps at the onset of winter. The drop in temperature has no relation to the pain in the foot. The cold weather brings forth lifestyle changes such as reduced or absence of physical activity.
This results in stiff muscles. Also, we tend to drink less water during winter than the warmer months. These habits pose as risk factors for leg cramps.
The probability and intensity of foot cramps increase with age as the body loses muscle mass with age. This results in an increasing pressure on the remaining muscles to support the body weight.
Foot cramps are usually noticed with poor diet, sports-related activities and pregnancy.
Proper warm up and stretching before exercise can prevent muscle fatigue and damage. As feet take the weight of the entire body, attention should be given to ankles and arches during warm-up stretching. Muscles can be made more resilient by walking and maintaining a good posture.
Leg pain in the night could also be a result of restless leg syndrome. The difference between cramps and restless leg syndrome is the symptoms.
The indication for restless leg syndrome is alleviation of the pain by moving the leg. However, a cramp can be relieved by stretching the muscles.
Home remedies and preventive measures can ease the symptoms usually. However, medical advice is needed for secondary causes of cramps such as medicine-induced and injury-related.
It is important to understand the cause leading to cramps to avoid accidental damage to a torn muscle.
Cramps are not a serious ailment and a healthy lifestyle can prevent the painful sensation. Although, an intense lingering pain and discomfort resulting in lack of coordination or inability to conduct daily activities should be notified to a physician.
12. https://bnf.nice.org.uk/treatment-summary/nocturnal-leg- amps.html