Do we really know the cause?

Most readers will be familiar with the painful sensations of cramp.  When the muscle settles and eases, a dull ache is often left behind. You might have to cease activity if the muscle keeps cramping and you may wake up the next day with the muscle feeling tender, but you should be able to function well. Night time cramp is unpleasant if it disturbs sleep. 


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Targeting muscles

abductor hallucis an arch muscle

While affecting our legs or thighs, our feet are affected in a peculiar way. The subject of cramp is by no means a small topic so let us address the key elements. There are medical reasons for cramping and stomach cramps that fall into this bundle of concerns and include monthly menstruation, but there is no record for the affected feet. However, sexual intercourse can set off foot cramps, a procreational exercise. The two areas likely to cause painful cramps are in the small muscles of the feet. If you want to be more academic, the inside arch has a muscle called the abductor hallucis, which attaches to the base of the big toe. This is a strip like muscle that inserts under the big toe and runs the length of the foot. 

The other group of seven small muscles that go into spasm are called the interossei and lie between the metatarsals together with worm like muscles called lumbricales. When these fire off, as I like to call it – in other words – contract, the pain is pretty horrible. Brett Sears [1] agrees with these observations when he describes the cramping scenario that can occur at night or in bed and wake you up with pain. The trouble is that cramps can occur in hot and cold at any time. You know when one of the interossei or lumbricales are affected as the toes can push downwards. 

So what about this salt argument?

Evidence

Salt is not just sodium chloride but calcium, potassium, magnesium, phosphate, bicarbonate. These chemicals are also known as electrolytes which are important for nerve conduction and health muscle function. One myth cramp was to eat a banana because this had potassium, a significant body salt. Athletes had their blood levels measured based on their loss of water in sweat and, hence, salt loss. The findings showed little difference between those who suffered cramp and those that don’t. Miller [2] tried to see if cramps could be produced by using an electric current in brave volunteers. It turns out that the scientific community has found no isolated cause for sudden eruptions of cramp.

What can you do about cramping?

Well, any podiatrist will tell you to ensure that your footwear fits and is not tight across the front of the foot – the widest part. A curious finding that you might consider anecdotal arises from the smaller interossei mentioned before going onto spasm, compressing an important digital nerve to be discussed in the next section. Brought on by tight cycling shoe gear, I paid a heavy price because the nerve was squashed in my narrow shoe. Returning to Miller’s work, he found that stretching did not prevent cramps in his 15 volunteers. He hypothesises that nerve innervation is more likely to be the culprit than dehydration.

Other causes ascribed to foot cramping

  • Age – we can blame age on everything if we want to find a cause! The truth is that lack of movement, stiff joints and lack of exercise are the real culprits. Regular exercise can help to a point of minor fatigue with pain. 
  • Footwear – podiatrists are naturally interested in footwear. The key elements are heel height design versus the real requirements of function. The forefoot is crunched up with narrow toe boxes which can lead to cramp as muscles cannot function as well if impeded. 
  • Medical conditions – multiples sclerosis, Parkinson’s disease, post stroke victims, lower limb blood supply insufficiency and diabetes are commonly associated with cramp and pain.

Is there a solution?

Stretching

When it comes to my own experience, I stretch out the cramped spasm aggressively. First, the toe muscles are flexed and extended manually by stretching out the toe tendons and their muscles by hand. Secondly, where the arch spasms, I stand and push down on the ball of my big toe (metatarsal head). By elongating the foot, the arch is stretched, aiding the muscle fibres. Forced stretching can help the immediate discomfort, but cramps can return. Again, hot or cold makes little difference, but I use bed socks if my feet are too cold and believe this helps.

Supplements

Of course, more severe forms of cramp exist, but in the case of the myth surrounding salt causing an isolated foot cramp, this appears more fiction than fact in its milder form. Jessica Richardson [3]  writes about magnesium supplements. Her warning, “Millions of Brits look to Amazon before purchasing their products, but most don’t realise that up to 60% of their reviews are written by individuals paid to leave positive feedback. Risking your health with reviews that are likely false is too dangerous a game to play when you’re choosing an ingestible supplement.”  

For most people reading this article the chance of poor mineral intake with a health diet is unlikely. Oral treatment is not necessary if cramp is occasional and as a foot cramp sufferer myself I accept this as part of the message my body gives out from time to time. Regular exercise and a healthy diet, monitoring my health, seeking medical support if needed is my main mantra. As far as foods are concerned we can derive all our nutrients from a range of products. The only problem might be with people who feel they cannot afford fresh fruit, vegetables and fish, or prefer heavier red meat. Today many people do not spend time cooking from scratch and so additives creep in complicating our diet and body chemistry. Although containing adverts this link does show a range of sixteen healthy foods [4] that maintain health and might help in some areas of mild deficiency. 

Orthoses

Although there are no studies, it is not unreasonable to use a foot support (orthosis) starting with the less expensive over the counter designs. There are plenty of outlets that will sell people supports at high cost and while not illegal the unwary member of the public can be persuaded to pay more than needed. As a podiatrist I naturally recommend someone with professional training in foot health. Vitamin B complex aimed at nerves and nerve conduction has been suggested but research is not substantial on the subject. The Mayo clinic (USA) suggests applying heat or cold using a warm towel or heating pad on tense muscles. It is probably easier to take a bath, but ice may relieve pain, more so if there is any injury.

Summary

The potential causes of cramp include:

  1. Lack of exercise
  2. Dehydration
  3. Poor nutrition and unhealthy diet
  4. Poor fitting footwear
  5. Age
  6. Medical conditions

You can also read my article on kidneys and salt regulation on this site and flat feet. 
Urine Holds the Secrets of Health and Time to challenge the flat foot 

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Myths about cramps features with other foot concerns in ‘Foot Health Myths, Facts and Fables’ which is FREE to download by signing-up to my regular newsfeed (go to ConsultingFootPain.co.uk) The book is also available from Amazon. 



Thanks for reading ‘Foot Cramp is there a cause?’ by David R Tollafield

Published by Busypencilcase Communications Est. 2015 for ConsultingFootPain
January 2022