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Why cramp in the calves of the legs and what to do?
Last reviewed: 12.07.2025

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Among these many symptoms, abnormal involuntary movements stand out - cramps and spasms, which include focal myoclonic cramps in the calves of the legs, which are quite painful contractions of the biceps gastrocnemius muscle (Musculus gastrocnemius).
Epidemiology
There are no domestic statistics on the occurrence of this symptom, but according to the American Academy of Family Physicians, up to 60% of adult patients and about 7% of children complain of cramps in the calves of the legs at night. Cramps occur slightly more often in women, and their frequency increases with age. [ 1 ]
Almost 20% of elderly people experience cramps in their calves and feet almost daily. In six to seven cases out of ten, calf muscle cramps occur at night – during sleep.
Causes cramps in the calves
Sometimes the cause of cramps in the calves of the legs is not clearly identified, so that primary cramps in healthy people can be considered idiopathic, for example, as a consequence of muscle fatigue, especially with insufficient fluid intake, which negatively affects the water-salt (electrolyte) balance of the body. [ 2 ]
Electrolyte imbalance can be caused by a calcium imbalance (hypocalcemia), a magnesium deficiency ( hypomagnesemia ), a potassium deficiency (hypokalemia), a low sodium level (hyponatremia), and an excess of phosphorus. [ 3 ]
Read more:
- Causes of increase and decrease of magnesium in the blood
- Causes of Low Blood Calcium (Hypocalcemia)
- Causes of increased phosphorus in the blood (hyperphosphatemia)
The causes that can be determined include:
- excessive strain on the calf muscles (in people with standing work) or their overexertion (long-term training in athletes); [ 4 ]
- dehydration (with diarrhea and frequent vomiting);
- circulatory problems in the legs, for example, with a sedentary lifestyle, sedentary work or prolonged bed rest, in the presence of varicose veins or thrombophlebitis. Phlebologists note that cramps in the calves of the legs at night - with swelling of the shins and feet - are clinical manifestations of chronic venous insufficiency;
- neurological conditions such as motor neuron disease (MSD) or neuropathy of the legs;
- pathologies of peripheral nerves, including the tibial nerve (Nervus tibialis), which provides innervation to the gastrocnemius muscle;
- narrowing of the spinal canal (stenosis), irritation or compression of a spinal nerve (radiculopathy), pinched nerve in the cervical vertebrae.
Cramps in the calf and other muscles can be a side effect of certain medications, such as diuretics, antihypertensive drugs, calcium channel blockers, statins, cholinomimetics, oral contraceptives, etc. [ 5 ]
Cramps in the calves of the legs during pregnancy are associated with the appearance of edema, weight gain, poor blood circulation in the lower extremities and a lack of trace elements. [ 6 ], [ 7 ] Full information about this in the material - Why do legs cramp during pregnancy and what to do?
Risk factors
Experts believe that the main risk factors for the occurrence of secondary (not related to physical activity) calf cramps are the predisposition of older people to them – due to the age-related tendency for the tendons that connect muscles to bone to shorten.
The likelihood of developing seizures increases with:
- physical activity in conditions of extreme heat or cold;
- excess body weight;
- lack of vitamins D and B;
- alcoholism;
- the presence of diabetes mellitus, in which a significant proportion of patients experience magnesium deficiency, low ATP levels, deterioration of blood supply to the lower extremities (due to diabetic angiopathy), as well as metabolic acidosis (primarily in decompensated diabetes mellitus);
- chronic renal failure;
- hemodialysis;
- liver diseases, including cirrhosis (with the accumulation of toxic substances in the blood);
- disorders of parathyroid gland secretion (hypoparathyroidism);
- adrenal insufficiency (Addison's disease).
By the way, the risk of developing morning cramps in the calves of the legs is not only all of the above, but also sleeping on your back at night: due to the pressure on the calf muscles and a decrease in blood flow in them. According to another version, when a person sleeps lying on his back, the feet are passively bent, and the fibers of the calf muscles are maximally shortened, so minor nerve stimulation can lead to a cramp. [ 8 ]
Pathogenesis
With increased physical exertion, the pathogenesis of cramps in the calves of the legs is associated with the fact that muscle tissue cells find themselves in hypoxic conditions - insufficient tissue respiration. Then the mitochondria of myocytes, under the influence of adenosine diphosphate (ATP), switch to anaerobic respiration through glucose catabolism - glycolysis. As a result, pyruvic acid is formed, which enzymes transform into lactate, i.e. lactic acid. When it accumulates in the muscles, cramps occur.
A cramp in the left or right calf of the leg that is not associated with physical exertion is the result of an electrolyte imbalance that provokes a short-term failure of the electrochemical mechanism that ensures the process of excitation of synapses of nerve cells (neurons) and the transmission of nerve impulses to muscle tissue cells.
This process can be disrupted by a decrease in the concentration of ATP, which is necessary for the oxidative phosphorylation of calcium channel proteins, their opening and the release of calcium ions that mediate the transmission of signals from the sarcoplasmic reticulum of myocytes to their membranes, where a difference in electrical potential is created, leading to the contraction of muscle tissue fibrils.
When the action potentials are exhausted, fast calcium pumps (oligomeric proteins ATPase), activated by sodium ions, return calcium back to the sarcoplasm, and the muscle relaxes. With a lack of sodium, ATPases do not work, calcium ions remain in the myofibrils, causing the muscles to contract and cause cramps.
Involuntary muscle contraction can also be caused by the fact that the level of the excitatory neurotransmitter acetylcholine increases in the synaptic cleft of the processes of nerve cells (axons) due to a lack of magnesium in the body, which, as an electrolyte, also participates in the regulation of the transmission of nerve signals by inhibiting the release of calcium and relaxing muscle fibers.
In addition, experts see the involvement of increased activity of the neuromuscular reflex arc in the area of receptors of tension, stretching and contraction of muscles – the organs of the Golgi tendon of muscle spindles – in the pathogenesis of convulsive spasms of striated skeletal muscles. [ 9 ]
Symptoms cramps in the calves
A spasm of the calf muscles can last from a few seconds to a few minutes, and the first signs that are felt at the onset of a cramp are a sudden tension of the biceps gastrocnemius muscle: from slight (accompanied by involuntary twitching of muscle fibers - fasciculation) to very strong and painful - tetanic muscle contraction. [ 10 ]
The muscle is hard to the touch, often with visible irregularities; the feet and toes also become stiff and tense; the feeling of tension affects both the popliteal fossa and the Achilles tendon area. In many cases, the leg hurts for some time after the cramp in the calf - in the back of the leg, below the popliteal fossa. [ 11 ]
But if there is pain in the calf of the leg like a cramp, then this may indicate deep vein thrombosis or atherosclerosis of the branches of the tibial artery; with sudden pain in the shin, one can suspect a muscle rupture or tendonitis. Read more in the publication - Calf pain
Calf cramps at night are considered "normal" in late pregnancy and can range in intensity from mild to quite painful.[ 12 ],[ 13 ]
Complications and consequences
If intense training causes severe cramps in the calves of the legs, then a day or two after such loads, excess lactate accumulates in the blood and muscle tissue. And this manifests itself not only in cramps and a feeling of burning and pain in the muscles, but also in weakness and nausea.
In some cases, consequences and complications arise from frequent and prolonged tetanic cramps, which can lead to weakening of muscles and tendon reflexes with partial atrophy of muscle fibers, as well as the development of intermittent claudication. [ 14 ]
Diagnostics cramps in the calves
If leg cramps occur occasionally, then medical diagnosis is not required. But when muscle spasms in the calves of the legs are frequent or unusually severe, are not associated with physical exercise, or do not improve with stretching and massage, then you cannot do without contacting a doctor.
The history is key, as physical examination rarely reveals seizures due to their unpredictability. However, the examination includes inspection of the legs and feet, palpation of impulses, and assessment of touch and prick sensation, strength and depth of tendon reflexes. Blood tests (complete blood count, biochemistry, sugar, electrolytes, creatinine, L-lactate, parathyroid hormone) and urine may be required. [ 15 ]
Instrumental diagnostics – muscle examination – in case of frequent secondary cramps is carried out using ultrasound of muscles, electromyography, ultrasound angiography (determining the condition of the leg vessels), etc.
Differential diagnosis
The physician must differentiate cramps from fasciculations in motor neuron diseases and motor-sensory disorders, from restless legs syndrome and nocturnal myoclonus, myopathic and neuropathic conditions, from tonic cramps in dyskinesias of cerebral or toxic origin, for which a differential diagnosis is carried out based on the anamnesis and examination results.
Who to contact?
Treatment cramps in the calves
Most calf cramps resolve spontaneously within a few seconds or minutes.
But what to do if the spasm is very strong and painful, how to relieve a cramp in the calves of the legs? A strong stretch of the contracted muscle by slowly and smoothly bending the ankle joint to the front of the shin (this is easy to do by holding the toes with your hand) quickly relieves pain. If the cramp does not go away the first time, you need to repeat the above action, or straighten the leg and lift it up, bending it at the ankle towards the shin. [ 16 ]
At the same time, it is necessary to massage the muscle, rubbing it with the palm or knuckles of your fingers clenched into a fist, and also pinching it with your fingers.
You can stand barefoot on a cold floor and lift your toes up, apply ice or a cold compress to the muscle. This will relieve pain, but a hot compress (hot water bottle) will help speed up muscle relaxation.
Treatment as such concerns cases of secondary seizures whose cause is known: etiologic drug therapy can help alleviate this symptom.
If the cramps are idiopathic, then a combination of exercises and drugs that help normalize electrolyte levels is usually recommended: Magne B6 forte (Magvit B6, Magnefar B6, Magnikum, etc.), Calcium glycerophosphate, Asparkam, containing magnesium and potassium aspartate or its synonym - Panangin. [ 17 ], [ 18 ]
You should take vitamins E, [ 19 ] D, B1, B6, B12 in courses.
And the antimalarial drug Quinine, which was previously used for seizures, has not been recommended by the FDA since 2004 due to its toxicity: there have been cases of fatal side effects caused by thrombocytopenia and the breakdown of red blood cells. [ 20 ], [ 21 ]
Muscle relaxant drugs are usually required only in the most persistent cases. Most often, Mydocalm (Tolperisone) is used - 0.05 g three times a day (during meals). The drug can have side effects in the form of headache and muscle weakness, as well as nausea and vomiting.
Do not look for special ointments or creams for leg cramps in the calves in pharmacies: they do not exist, but ointments with menthol, camphor and clove essential oil can help. These are ointments Efkamon (Gevkamen (Flucoldex) and Bom-benge. And also ointments with capsaicin - Espole or Nikoflex, ointment with bee venom Apizartron (Virapin).
Homeopathy recommends: Magnesia Phosphorica or Magnesium phosphoricum salt of Dr. Schlusser No. 7, Kali phosphoricum, Gnaphalium Polycephalum, Rhus Toxicodendron, Aconitum Napellus.
Physiotherapy treatment
For calf muscle cramps, physical therapy treatment includes massage and stretching exercises.
Exercise 1: Stand facing the wall at arm's length and leaning your palms on it, lean forward - without bending your legs and without lifting your heels off the floor; hold this position for 5-10 seconds and return to the starting position. Start with 5 repetitions, increasing to 15-20.
Exercise 2: stand in exactly the same way, but with one leg slightly bent at the knee and extended forward; when leaning towards the wall, the heel of the straightened leg does not come off the floor. Hold this position for 15-20 seconds; change legs, then alternate them for 5 repetitions.
Exercise 3: Stand on a step (fitness step) with the front of both feet, with your heels hanging over the edge. Slowly lower your heels below the step; hold for a few seconds and return to the starting position. Repeat 10-15 times. [ 22 ]
Folk remedies
For cramps, folk remedies suggest rubbing the calf muscles with bischofite, which contains magnesium and calcium chlorides. [ 23 ] This remedy cannot be used for skin, cardiovascular and oncological diseases.
It is also recommended to take baths with Epsom salts (magnesium sulfate heptahydrate), and if you sweat a lot, drink water slightly salted with regular table salt.
It is useful to drink water with added apple cider vinegar once a day (in the evening) (a tablespoon per glass of warm water, you can add a teaspoon of honey).
To rub the muscles, make an oil mixture based on regular vegetable oil (4 tablespoons of refined sunflower oil) with the addition of 20 drops of clove essential oil.
In case of cramps, herbal treatment is limited to peppermint and thyme, preferably fresh, as dried plants lose a significant portion of magnesium. It should be taken into account that mint is contraindicated in case of hypotension, varicose veins and pregnancy, and thyme should not be used by pregnant women or people with kidney disease or stomach ulcers. [ 24 ]
Phytotherapy also recommends drinking decoctions of rose hips, wild pansies and bogbean. The decoctions are prepared at the rate of a tablespoon of dry grass per 250 ml of water, taken 50 ml two to three times a day.
Ginger root contains a lot of magnesium, so it is advisable to drink ginger tea to reduce muscle spasms and, ultimately, to eliminate them completely. [ 25 ]
Prevention
The best prevention of calf muscle cramps is moderate physical activity, which helps to activate blood flow and improve muscle tissue trophism. Therefore, athletes warm up before training.
And for people who are far from sports, it is useful to do several light stretches of the calf muscles in the morning and evening (the exercises were described above).
Also consider the following expert tips:
- don't overexert yourself, listen to your body and don't try to go beyond your limits;
- wear comfortable shoes;
- drink enough water;
- Limit your intake of alcohol and coffee, as they can deplete fluid from the body;
The diet should include more foods that contain a lot of magnesium (bran bread, legumes, nuts, bananas, black currants, cherries, dried apricots, prunes, persimmons, seaweed, spinach, parsley and dill, sea fish), potassium (raisins, nuts, jacket potatoes, bananas, apricots, tomatoes, oatmeal, buckwheat), calcium (dairy products, cabbage, garlic, parsley).
Forecast
For most people, the prognosis for occasional cramps in the calves is favorable. If the cramps are regular, then, given their possible causes, this symptom can be considered chronic, requiring treatment of the underlying pathology.