Leg cramps are observed in vascular diseases, crumpy syndrome, flat feet, electrolyte imbalance, hypovitaminosis, a number of endocrine diseases, poisoning, drug overdose, brain damage, and some other conditions. They can cover one muscle or several muscle groups, be isolated or combined with convulsions of other localizations. Diagnosed on the basis of survey data, external examination, EFI, laboratory tests, hardware methods. Treatment includes muscle relaxants, antiepileptic and anticonvulsants, antispasmodics, physiotherapy techniques, and surgical interventions.
Why do leg cramps occur?
crumpy syndrome
It is short-term painful muscle contractions. It is extremely widespread, according to various sources, it is detected in 20-90% of adults, it is more common in old age. It can occur as a physiological reaction to various external influences, be idiopathic or symptomatic. In the vast majority of cases, the calf muscles are affected.
During a cramp, sharp pain and plantar flexion of the foot are noted. Manifestations persist for several seconds or minutes, decrease when walking, massage, passive extension of the foot. After an attack within 1-2 days, there is a slight soreness, increased sensitivity of the calves. The syndrome often appears at night, preceded by fasciculations. Caused by the following circumstances:
- physical factors. Cramps in the legs are disturbing after an unusual intense load - a long walk, exercising on simulators. They develop in water, especially cold, which is associated with the danger of drowning. Other irritants are dehydration, hypothermia, the use of salty foods.
- Idiopathic cramps. They appear for no apparent reason, they are found both at rest and during movement. Seen daily or several times a week. May be associated with a hereditary predisposition (detected in several members of the same family).
- Somatic diseases. Cramps are potentiated by chronic renal failure, cirrhosis of the liver, chronic heart failure, rarely by glycogenosis, paraneoplastic syndrome.
- neurological diseases. The syndrome occurs against the background of pathologies with hypertonicity and spontaneous muscle activity: ALS, multiple sclerosis, Parkinson's syndrome, Charcot-Marie-Tooth disease, crumpy-fasciculation syndrome. Sometimes it accompanies osteochondrosis, mono- and polyneuropathy.
flat feet
Leg cramps are determined with all types of flat feet: longitudinal, transverse, mixed. They are caused by improper distribution of the load, which entails constant overwork of the muscles of the distal extremities. More often noted in the afternoon, develop after prolonged standing or walking. May disturb at night.
Vascular diseases
Spasms in vascular diseases are due to the deterioration of metabolic processes, hypoxia, and a decrease in the amount of ATP in cells. They are found in the following pathologies:
- Varicose disease. The symptom worries mainly in the stage of decompensation, more often observed at night. It is combined with increased fatigue, edema, dull pain, constant heaviness in the legs, pronounced external changes in the veins, and trophic disorders.
- obliterating atherosclerosis. It is more often diagnosed in older people. Pain and cramps in the calf muscles are preceded by numbness of the feet, burning, chilliness, increased sensitivity to cold. After a certain period of time (usually insignificant), intermittent claudication joins the listed symptoms.
- Obliterating endarteritis. Young men predominate among the patients. Symptoms resemble the clinical picture of atherosclerosis, include chilliness, numbness of the fingers, paresthesia, spasms in the feet and calf muscles, intermittent claudication. Characterized by a less favorable course, the rapid development of trophic disorders.
- Thromboangiitis obliterans. Always bilateral. Along with convulsions, pain, hypersensitivity of the feet, hemorrhages in the area of the fingers, Raynaud's syndrome, migratory thrombophlebitis of the distal legs are found. With progression, severe trophic disorders occur.
Endocrine diseases
The convulsive syndrome is most characteristic of hypoparathyroidism, due to an increase in neuromuscular excitability with a low level of parathyroid hormone. As a rule, first the arms are involved symmetrically, then the legs, the flexors are mainly affected. Sometimes convulsions spread to the facial muscles, muscles of the trunk, internal organs. In mild cases, attacks last 1-2 minutes, repeated 1-2 times a week. In severe cases, there are many daily paroxysms lasting up to several hours.
In some cases, spasms disturb patients with severe thyroid dysfunction in hyperthyroidism and hypothyroidism. May be associated with myoclonus, cognitive and behavioral disorders. In diabetes mellitus, the cause of cramps in the legs is diabetic macroangiopathy, which occurs 10-15 years after the onset of the disease, is found in approximately 10% of patients. The symptom is complemented by chilliness, numbness of the feet, swelling, sharp pain in the legs, thighs, and sometimes the buttocks, which is aggravated by movement.
Water and electrolyte disturbances
Tonic convulsions caused by changes in electrolyte balance occur in diseases of the gastrointestinal tract (malabsorption, condition after resection of the stomach and intestines), kidney disease, endocrinopathies. The cause can also be external and internal bleeding, intestinal infections, poisoning, accompanied by repeated vomiting, frequent diarrhea. The symptom is determined under conditions such as:
- Hypocalcemia. Foot cramps are combined with spasms of the hands, mimic and chewing muscles.
- Hypomagnesemia. Carpopedal spasm is complemented by trembling of the extremities, hyperreflexia, tetany, weakness, drowsiness, and dyspeptic disorders.
- Hyperkalemia. Convulsive attacks are short-term, quickly replaced by a decrease in muscle tone. Bradycardia, arrhythmias, pain in the epigastric region are detected.
- Hyper- and hyponatremia. Unlike other conditions, the symptom is generalized. Paroxysm is preceded by respiratory disorders, nausea, vomiting.
Hypovitaminosis
Violations of the contractile function of the muscles are most often found with a deficiency of B vitamins:
- Hypovitaminosis B1. Cramps in the muscles of the lower leg are characteristic of the dry form of beriberi. Neuritis, changes in pain and temperature sensitivity of the lower extremities are noted.
- Hypovitaminosis B2. Neurological disorders are determined with a long course of the disease, include spasms, paresthesia, ataxia, hyperreflexia. The listed symptoms are preceded by weakness, lesions of the eyes, skin and mucous membranes.
- Hypovitaminosis B6. The convulsive syndrome develops at night. Complemented by decreased vision, conjunctivitis, dry skin. The tongue becomes crimson, takes on a varnished appearance.
Intoxication and poisoning
Spontaneous cramps in the legs, other parts of the body are associated with an overdose of the drug or an individual reaction to the drug. The cause of the symptom is most often drugs from the group of calcium channel blockers, beta-blockers, statins, diuretics. Sometimes a symptom develops under the influence of acetylcholinesterase inhibitors, steroid hormones, nootropics, a number of psychotropic and antibacterial agents.
In some patients, convulsive syndrome appears at the exit from anesthesia with the use of muscle relaxants. The list of toxic substances that can provoke local (including in the legs) or generalized convulsions includes dichlorvos, other insecticides, and pesticides. Arsenic, formaldehyde, phenol, as well as ergot, belladonna and fly agaric have a similar effect.
Pathologies of pregnancy
Convulsions caused by inferior vena cava syndrome appear in the 2nd or 3rd trimester of pregnancy. They are caused by compression of the vessel by the growing uterus and, as a result, impaired blood circulation in the legs. The symptom is detected in the supine position, in the later stages it is combined with postural hypertension, dizziness, palpitations, increased fetal movements.
With eclampsia, convulsions are generalized. They begin with small twitches of the facial muscles, turn into spasms of the muscles of the upper and lower extremities and end with convulsions covering the entire body. Develop once or "series" of several attacks. Then a coma is formed, which is replaced by a gradual restoration of consciousness or a deterioration in the condition, followed by a fatal outcome.
Other reasons
There are many conditions in which leg cramps occur but are not a specific symptom or, as in eclampsia, become generalized. Spasmodic contractions are possible with sun and heat stroke. Can be detected in patients with posthemorrhagic anemia due to massive blood loss. They are found in epilepsy, TBI, cerebral tumors. Meet with tetany, myotonia, some myopathies.
Diagnostics
Diagnostic measures are carried out by a neurologist. According to the indications, patients are referred to an orthopedist, vascular surgeon, obstetrician-gynecologist, and other specialists. The examination program includes the following methods:
- Interview. The doctor specifies when the spasms first appeared, how often they repeat, what provokes seizures. Clarifies other complaints. Asks about existing diseases, lifestyle habits, medications taken to determine the possible causes of the symptom.
- Physical examination. During the examination, the specialist reveals changes in the legs: signs of flat feet, hypertrophy or increased muscle tone, fasciculations, dilated superficial veins, and edema. Assesses pulsation, examines sensitivity, reflexes.
- Electrophysiological studies. Electroneurography and electromyography help to determine the state of neuromuscular transmission, the speed of passage of nerve impulses, the presence or absence of spontaneous muscle activity, which in some cases indicates a possible cause of seizures.
- Laboratory tests. Screening examination includes KLA, OAM, determination of glucose, creatinine, urea, liver enzymes, blood proteins. In case of water-electrolyte disorders, the level of electrolytes is examined, in case of hypovitaminosis, the content of vitamins is evaluated, in case of endocrine pathologies, tests for hormones are performed. In case of poisoning, toxicological tests are performed.
- hardware methods. Patients with vascular diseases are shown ultrasound examinations (Dopplerography, duplex scanning) of the vessels of the lower extremities. For patients with flat feet, load-bearing radiography of the feet is recommended. With endocrine diseases, ultrasound of the endocrine glands is performed, with organ lesions - ultrasound of the abdominal cavity and kidneys. To exclude neurological pathologies, an MRI of the brain is performed.
Treatment
Conservative therapy
Therapeutic tactics is determined by the cause of leg cramps. Taking into account the characteristics of the pathology, the following methods are used:
- Crampy syndrome. With symptomatic spasms, therapy of the underlying disease is indicated. To eliminate convulsive activity, antiepileptic drugs, calcium channel blockers, quinine are used. Muscle relaxants are prescribed to relieve seizures. In case of severe pain syndrome, NSAIDs are included in the treatment regimen, and in case of sleep disorders, soft hypnotics are used.
- Flat feet. The leading role is played by non-pharmacological methods. Patients are advised to normalize weight, choose comfortable shoes, and avoid prolonged static loads. To strengthen the arch of the foot, walking on small stones, massage, special exercises, SMT, magnetotherapy, and other physiotherapy procedures are useful. If necessary, carry out the selection of orthopedic shoes.
- Vascular diseases. Therapy of varicose veins is carried out with the use of venotonics, physiotherapy exercises, means of elastic compression, methods of compression sclerotherapy. It is necessary to reduce the load on the legs. Drug treatment of obliterating diseases of the arteries is performed with antispasmodics, anticoagulants, thrombolytics, analgesics. Within the framework of non-drug therapy, ILBI, ozone therapy, hyperbaric oxygenation, balneological and physiotherapeutic procedures are prescribed.
- Endocrine diseases. Hypoparathyroidism is corrected by diet, taking calcium and vitamin D supplements, sedatives, anticonvulsants. Useful UFO. Hypothyroidism is treated with hormone replacement therapy, patients with hyperthyroidism are prescribed thyreostatics. Diabetes with macroangiopathy requires insulin therapy in combination with antiplatelet agents.
Violations of the water-electrolyte balance are eliminated by intravenous administration of electrolyte solutions. Vitamin preparations are recommended for patients with hypovitaminosis. In case of intoxication, detoxification therapy is required. Pregnant women with SNCS are advised to sleep on their left side, moderate exercise. Eclampsia is an indication for complex resuscitation.
Exercises for leg cramps
Surgery
Patients with seizures can perform the following operations:
- Flat feet: various options for Hallux valgus correction, tendon transplantation, resection of bone sections.
- Varicose disease: phlebectomy, miniphlebectomy, adhesive obliteration, laser and radio frequency coagulation, cryophlebectomy.
- Obliterating vascular diseases: endarterectomy, stenting, dilatation or prosthesis of arteries, bypass interventions, arterialization of foot veins, profundoplasty, thromboembolectomy.
- Endocrine pathologies: resection of the thyroid gland in patients with hyperthyroidism, endarterectomy and plasty of trophic ulcers in diabetic macroangiopathy.