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Saturday, August 21, 2010

Calf Cramps: Common Causes and Diagnosis Not To Miss

     Calf cramps are a very common problem seen in my practice. I have experienced severe nocturnal cramps after too much basketball, or too many miles, as have many of my patients. I eat a daily banana with my morning coffee as a preventative measure. I need to drink more as the articles below discuss since dehydration is a big factor. I am always slightly dehydrated and have a mental block about drinking more (one of my many mental blocks). I have always found good stretching right after your workout of any muscle that cramps, and then one more time before bed, can greatly diminish or eliminate these cramps. If you have disc disease in your low back, the associated nerve root can cause severe leg cramps (after you lie down) in the muscle groups involved. Finding the right position of your spine in bed, and sometimes getting a new bed or mattress, can be important. So, dehydration, low potassium or sodium, low carbohydrates, tight muscles, strenuous exercise with a buildup of lactic acid or other waste products, low back irritation, and poor circulation are truly the main causes of cramps, mild to severe. Before I present my story about Doug, please glance through these links below so you can see what is out there for the consumer and why I want to tell (and slightly brag) Doug's story.

     Doug presented to my office for a 2 week followup appointment after fracturing his right 5th metatarsal and being placed in a removable cast. This is a routine procedure. After about 10 days in the cast, he no longer had any foot pain in the fracture area, but began to get calf cramping on the side of the fracture. The calf cramping steadily got worse over the 3 days before his normal followup visit. The night before his visit he could not sleep because of the pain caused by the cramping. Removing the cast did not help his symptoms, and stretching the muscles did not help. It is easily explained by some dehydration, some electrolyte imbalance (have another banana), some tightness developing in the cast in an already tight calf, and some restriction of the circulation from the velcro straps holding the cast on his leg. These are all common causes by themselves of cramping, and they are exaggerated when several co-exist together. I also thought Doug may have tweaked his low back with the cast, even though he had an Even-Up, which could have been a 5th factor. It could have been easy to have dismissed it, simply giving the typical advice of stretching, drinking, massage, but something was different that is hard to put into words.There is definitely a sixth sense that plays out here (and I believe in guardian angles also). Doug knew his body, and something was not making sense. Red Flags went up. Doug was concerned. I listened. We decided to rule out the one in ten thousand chance he had a blood clot in his leg. This is never mentioned in the articles above, because it is rare. He had none of the predisposing factors for blood clots, except the slight foot fracture.

Doug went that day to get an ultrasound to rule out a one in ten thousand chance that he had a blood clot, AKA Deep Vein Thrombosis. He called me 8 and 1/2 hours later, first availbability of getting that test, that the test was positive and he was on his way to the ER to be started on blood thinners. What a day!! Boy, did I feel good after that call that we had not missed it. But, Doug and his family probably felt better, much, much better, especially when you read the stats.

To all the articles on leg cramps, I say add an asterick for this possibility (call it Doug's Law). To Doug, I am glad you listened to your body, and I am glad this blog/this story can hopefully help someone else. Golden Rule of Foot: Increasing Leg Cramps over several days should be worked up for DVT.


  1. Hi Dr. Blake,
    I find that stretching out the top of the foot (stretching the ankle dorsiflexors and toe extensors) has been very helpful for many of my patients (the muscles opposite to the ones that are cramping.) It is not uncommon that the weight of the blankets and positions that we assume in bed at night place the foot into a more plantar flexed position than it is used to assuming. This places the toe flexors and ankle plantar flexors in a very shortened position which can be a cause of cramping.
    Nancy Bryan, PT, MA

  2. Nancy, Thank you so very much for your extreme input. Nancy in my mind is one of the best PTs in the world!! Rich Blake It makes so much sense, I never thought of this.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.