For leg: Leg cramps: Causes, treatment, and prevention
Leg cramps: Causes, treatment, and prevention
Why leg cramps, or Charley horses, occur is often not clear. But, they may result from nerve dysfunction, shortened leg muscles, and various health conditions, such as diabetes and kidney failure. Stretching the muscle may bring relief, but an underlying condition will need medical attention.
Leg cramps involve sudden, painful, and involuntary contractions of a leg muscle, causing pain and discomfort in the feet, calves, and thigh muscles
They often occur while a person is sleeping or resting. They can be gone in a few seconds, but the average duration is 9 minutes. They can leave tenderness in the muscle for up to 24 hours after.
In most cases, there is no identifiable reason why they happen, and they are harmless. Sometimes, however, they can indicate an underlying disorder, such as diabetes or peripheral artery disease.
In most cases, people do not know why leg cramps happen, although there are a number of theories.
Some research suggests that muscle fatigue and nerve dysfunction may play a role.
Sleeping with the foot stretched out and the calf muscles shortened may trigger night cramps.
Another theory is that cramps are more likely nowadays, as most people no longer squat, a position that stretches the calf muscles.
Exercise is a factor. Stressing or using a muscle for a long time may trigger a leg cramp during or after the exertion. Cramps often affect athletes, especially at the start of a season, if their body is out of condition. Nerve damage may play a role.
Some experts believe dehydration and electrolyte imbalances may contribute. Athletes who exercise strenuously in hot weather often experience cramps. However, scientific evidence has not confirmed this connection. Athletes who play in cool climates also get cramps, after all.
Sometimes leg cramps are caused by an underlying condition relating to the nervous system, circulation, metabolism, or hormones. Some medications can also increase the risk.
Conditions that may cause cramps include:
- alcohol misuse
- chronic kidney failure
- cancer treatment
- muscle fatigue
- vascular disease
- Parkinson’s disease
- peripheral artery disease (PAD)
- restless legs syndrome
- pregnancy, especially in the later stages
- motor neuron disease
- Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS)
- spinal nerve irritation or compression
- hardening of the arteries
- spinal stenosis
- thyroid disease and hormonal problems
- chronic infections
- chronic obstructive pulmonary disease (COPD)
- chronic kidney disease and kidney failure
- diabetes, especially type 2 diabetes
Medications that can trigger cramping include:
- iron sucrose (Venofer)
- conjugated estrogens
- raloxifene (Evista)
- naproxen (Aleve)
- teriparatide (Forteo)
Older people are more likely to experience leg cramps. Muscle loss starts from the mid-40s and increases if a person is not active. This may raise the risk of cramps.
Research suggests that 50–60% of adults and 7% of children experience cramps, and the likelihood increases with age.
The American Academy of Orthopaedic Surgeons (AAOS) suggest the following to ease cramping:
- Stop the activity that caused the cramp.
- Stretch and massage the muscle.
- Hold the leg in the stretched position until the cramp stops.
- Apply heat to muscles that are tight or tense.
- Use cold packs on tender muscles.
Some people use supplements, such as magnesium, to reduce muscle cramps. However, a 2020 review that looked at older adults concluded that they were unlikely to benefit from this treatment. For other contexts, such as pregnancy, there is not enough evidence to show whether supplements help.
Stretching before bedtime may help, but evidence is limited.
No medication is likely to prevent leg cramps.
If a severe cramp leaves a muscle feeling tender, an over-the-counter (OTC) painkiller may help.
In the past, people used quinine. However, the Food and Drug Administration (FDA) urge people not to use this, as it may have dangerous interactions and side effects.
There is limited evidence that exercise and stretching, calcium channel blockers, carisoprodol, and vitamin B-12 may help. Multivitamins may be of some use during pregnancy.
There is no evidence that nonsteroidal anti-inflammatory drugs (NSAIDs), calcium, or potassium are of any benefit.
Here, learn more about treating leg muscle cramps.
If there is no underlying cause, leg cramps will probably get better without treatment.
Walking on tiptoes may help stretch the muscles and relieve a cramp.
Stretching exercises may help. If the cramp is in the calf muscle try the following stretches:
Hamstring muscle stretch
Image credit: Zinkevych/Getty Images
- Sit on the floor with legs straight out in front.
- Pull the toes up toward the knee, to stretch the calf muscle.
- Hold for 30 seconds.
Calf muscle stretch
- Stand about one meter from a wall with both feet flat on the ground.
- Lean forward against the wall with the arms outstretched and the hands flat on the wall. Keep the heels on the ground.
- Hold for 10 seconds, then gently return to an upright position.
- Repeat 5-10 times.
Quadriceps muscle stretch
- Stand up straight, holding a wall or chair for support if necessary.
- Pull one foot up toward the buttocks, grasp and ankle, and hold the foot as close to the body as far as possible.
- Hold for 30 seconds, then repeat with the other foot.
Doing these exercises may help relieve or prevent cramps. They can also serve as a warm up before exercise.
The following measures may also help prevent leg cramps.
- Support the toes when lying down or asleep by propping up the feet with a pillow.
- Keep bedding loose to help prevent the feet and toes from pointing downward during sleep.
- Wear suitable footwear during the day, especially if a person has flat feet or other foot problems.
Keeping fit by getting enough exercise can help. If a person does exercise, they should make sure their program is suitable and that their progress is gradual. Avoid overexertion and training for prolonged periods, and always remember to warm up before starting.
Leg cramps are not usually a cause for concern, but sometimes they can indicate an underlying problem. If cramps are severe or happen frequently, it may be a good idea to seek medical advice.
The doctor may carry out tests to try to identify an underlying cause. If the person is taking medications that can trigger cramps, the doctor may adjust the dose or change the drug.
Leg cramps are a common problem that usually happen for no identifiable reason. Stretching and massaging the muscle can often bring relief.
In some cases, however, there may be an underlying cause that needs medical attention. If cramps are severe or frequent, consider consulting a doctor.
Venous leg ulcer – Illnesses & conditions
With appropriate treatment, most venous leg ulcers heal within 3 to 4 months.
Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a practice or district nurse.
Cleaning and dressing the ulcer
The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.
A simple, non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.
To improve vein circulation in your legs and treat swelling, your nurse will apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart.
There are many different types of bandage or elastic stockings used to treat venous leg ulcers, which may be made in 2, 3 or 4 different layers. The application of a compression bandage is a skilled procedure and they should only be applied by trained healthcare staff.
The bandage is changed once a week, when the dressing is changed.
When compression bandages are first applied to an unhealthy ulcer, it’s usually painful. Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP. The pain will lessen once the ulcer starts to heal, but this can take up to 10-12 days.
It’s important to wear your compression bandage exactly as instructed. If you have any problems, it’s usually best to contact your nurse, instead of trying to remove it yourself. If the compression bandage feels a little too tight and is uncomfortable in bed at night, getting up for a short walk will usually help.
However, you’ll need to cut the bandage off if:
- you get severe pain at the front of your ankle
- you get severe pain on the top of your foot
- your toes become blue and swollen
Once you remove the bandage, make sure you keep your leg highly elevated and contact your doctor or nurse as soon as possible.
In some clinics, specialist teams are using new alternatives to compression bandages, such as special stockings or other compressive devices. These may not be available in every clinic but could change the way ulcers are treated in future. Your specialist will be able to advise you whether a different approach may help you.
Treating associated symptoms
Swelling in the legs and ankles
Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid. This can be controlled by compression bandages.
Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep.
You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid standing or sitting still with your feet down. You should elevate your feet at least every hour.
Some people with venous leg ulcers develop rashes with scaly and itchy skin.
This is often due to varicose eczema, which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. In rare cases, you may need to be referred to a dermatologist (skin specialist) for treatment.
Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.
It’s important to avoid scratching your legs if they feel itchy, because this damages the skin and may lead to further ulcers.
Looking after yourself during treatment
To help your ulcer heal more quickly, follow the advice below:
- Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse
- Whenever you’re sitting or lying down, keep your affected leg elevated – with your toes level with your eyes
- Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation
- If you’re overweight, try to reduce your weight with a healthy diet and regular exercise
- Stop smoking
- Moderate your alcohol consumption
- Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear
You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation, for support and advice.
Treating an infected ulcer
An ulcer sometimes produces a large amount of discharge and becomes more painful. There may also be redness around the ulcer. These symptoms and feeling unwell are signs of infection.
If your ulcer becomes infected, it should be cleaned and dressed as usual.
You should also elevate your leg most of the time and you’ll be prescribed a 7-day course of antibiotics.
The aim of antibiotic treatment is to clear the infection. However, antibiotics don’t heal ulcers and should only be used in short courses to treat infected ulcers.
You should visit your nurse once a week to have your dressings and compression bandages changed. They’ll also monitor the ulcer to see how well it’s healing. Once your ulcer is healing well, your nurse will see you less often.
After the ulcer has healed
Once you’ve had a venous leg ulcer, another ulcer could develop within months or years.
The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself.
Various accessories are available to help you put them on and take them off.
Read more about preventing venous leg ulcers.
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Sand off any sharp edges that could damage the bandage or splint before use.
Hold the plastic ring firmly when putting on the bandage or splint.
To ensure proper protection against water penetration, make sure that the protective surface of the product fits snugly enough to cover the entire surface of the dressing or splint.
Make sure that the diaphragm of the protective product is dry before removing the product.
Hold the plastic ring firmly when removing.
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