Come a bit closer, my young NYC podiatry patients I want to talk about something slightly embarrassing. It happens at night when we are in bed, trying to sleep that sleep of dreams, although it can also happen during the day. It’s a bit painful and causes the extremities to become stiff and rigid. I am referring, of course, to leg cramps, which we need to talk about (you thought maybe I was referring to something else?).

Leg cramps are a very common problem, and a bit of a conundrum. The majority of cramps are benign and need only treatment for the symptoms. In general, leg cramps may occur during the day around exercise or when lying in bed at night. Both types of cramps can happen due to muscle exertion or slight dehydration, although the clinical manifestation is somewhat different.

Daytime cramps that happen during exercise are often due to muscle exertion, and first line treatment and prevention is aimed at resting the affected limb and ensuring that there is adequate warmup and stretch before any routine. Nighttime cramps are often positional, and occur in a relaxed limb that contracts downward. This causes a contracture of the muscles, leading to a severe and sometimes painful tightening of the muscle belly, also known as a Charley Horse. Both types of cramps can be triggered by slight dehydration and specifically a decrease in potassium and magnesium levels. These are not the serum levels measured by a blood test; those should remain at a physiologically normal level. It’s the levels within the muscles that are affected, and lower levels will decrease the threshold at which the muscles contract. Ingestion of foods rich in potassium and magnesium as well as hydration with electrolyte drinks or water can also be beneficial. Ugh- please pardon the uncanny resemblance of the explanation to a 1950’s documentary- the physiology is not fully understood, and it’s easier to explain the what than the why.

The bottom line is drink plenty of water, have a banana or some orange juice, and stretch before you exercise and as you feel a cramp starting. If the cramps continue and affect sleep or exercise regularly see your friendly local NYC podiatrist. And whatever you do, take care of your shoes (song reference anyone?).

See you in the office.

Ernest Isaacson

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Ernest L Isaacson DPM PC
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