Feet cramps at night

Patient

Q: Only when sleeping, I have occasional terrible feet cramps. Last evening my two middle toes were hard as a stone and seperated like a piece sign. I could not move them back together. Stretching and walking does not work. Putting my feet in a warm or hot bath water evenutally works. What do you think this could be? I am 45, moderately to midly active and have no other health issues.

Doctor

A:   Muscle cramps are extremely common, and nearly everyone experiences a cramp at some time in their life. Cramps are common in adults and become increasingly frequent with aging. Any of the muscles that are under our voluntary control (skeletal muscles) can cramp.
Cramps of the extremities, especially the legs and feet, and most particularly the calf (the classic "charley horse"), are very common, especially at night time .
Muscle cramps are felt to be caused by excessively excited nerves that stimulate the muscles. This can occur particularly after injury to nerve and/or muscle; dehydration with low blood levels of calcium, magnesium, or potassium; from certain medications; and even at rest.
The pain that is associated with muscle cramps that are caused by poor circulation to the legs that worsens with walking is referred to as claudication. Deficiencies of certain vitamins or minerals, including iron deficiency, thiamine (B1), pantothenic acid (B5), and pyridoxine(B6), can also cause muscle cramps.
Muscle cramps usually cause a temporary nuisance and typically resolve on their own without treatment. When muscle cramps continually recur, it is time to seek an evaluation by a physician. The primary treatment of muscle cramps involves methods to relax the affected muscle.
This typically involves stretching, massage, and heat application. Other treatments are directed toward the underlying cause of the muscle cramps and can include rehydration, electrolyte repletion, hormone treatment, calcium supplementation.
Most cramps can be stopped if the involved muscle can be stretched. For many cramps of the feet and legs, this stretching can often be accomplished by standing up and walking around. For a calf muscle cramp, the person can stand about 2-2½ feet from a wall (possibly farther for a tall person) and lean into the wall to place the forearms against the wall with the knees and back straight and the heels in contact with the floor. Another technique involves flexing the ankle by pulling the toes up toward the head while still lying in bed with the leg as straight as possible. Gently massaging the muscle will often help it to relax, as will applying warmth from a heating pad or hot soak. If the cramp is associated with fluid loss, as is often the case with vigorous physical activity, fluid and electrolyte (especially sodium and potassium) replacement is essential.
Medicines are not generally needed to treat an ordinary cramp that is active since most cramps subside spontaneously before enough medicine would be absorbed to even have an effect.

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