Warding Off Muscle Cramps As We Age

If you're over 65, you probably know what a "charley horse" is. You may have gotten them during strenuous exercise as a younger person. But in older age, muscle cramps can be unlike any you've ever had before. That's because like so many other things in our bodies, our muscles and nerves wear out and function less effectively as we age.

"A cramp is a sudden painful contraction of a muscle that becomes rock hard," says Dr. Robert Miller, a neurologist who specializes in muscle cramps at the California Pacific Medical Center and teaches at University of California, San Francisco. "The muscle goes into a spasm and squeezes all the little nerve endings inside the muscle, and creates pain, and definitely ... gets your attention until you do something about it."

Uncontrollable Muscle Spasms

For Ken Holladay, 71, his muscle cramps started off mild and irregular. At first, he got them once every few weeks, but then they started to get more frequent. Eventually, they occurred every single night — often twice, between 2 a.m. and 6 a.m. It was a painful version of a charley horse, only it was in his feet and toes: "The big toe was at 90 degrees to the bottom of the foot; put your foot on the floor, and this big toe would be pointing straight up toward the ceiling; and I don't believe you can voluntarily pull a big toe that high."

Keeping Your Feet Happy
But as it turns out, your muscles can, all on their own. Holladay says that one time his toe actually curled down, "and I leapt out of bed to try and get rid of the pain and landed on that toe and broke the toe, broke the bone underneath that big toe, broke the toenail off." It was terrible, he says.

And since the cramps typically occurred twice every night, it was impossible to get a good night's sleep or feel well-rested during the day. But that's not what drove Holladay to seek treatment. What really scared him, he says, was the possibility that, as he got older, he might become bedridden due to disease or injury. If that happened, Holladay says, he wouldn't be able to get out of bed and walk, stretch and flex his muscles. He would just have to lie there, in terrible pain.

It was too scary a thought.

Searching For Treatment
So, Holladay went searching for help and treatment. First his doctor had to determine whether the spasms were an indicator of any other muscle or nerve degenerative disease, like ALS. With that established, Holladay tried a number of potential treatments: acupuncture, and then prescription quinine, which has since been taken off the market as a treatment for muscle cramps due to concerns about side effects. Neither one worked.

Finally he drove over an hour to see Dr. Yuen So, director of the neurology clinic at Stanford University. As it turned out, So and colleagues had just finished an evidence-based review of treatments for muscle cramps. Unfortunately, they turned up little. There were hundreds of studies but no conclusive or compelling evidence that any particular treatment would work for all or even most patients.

Dr. Hans Katzberg headed the review. Katzberg says some treatments held promise, including a certain type of calcium channel blocker used to treat blood pressure, as well as Vitamin B complex. Even with them, however, results were not convincing. "We were surprised to find out how little is documented in the treatment of cramps," says So. "A lot we do in medicine is based on anecdotal experience, and in this case, a lot of the treatments we use fall into the unproven category."

For Holladay, So ended up prescribing an anti-seizure medication. The meds worked.

"After a week or two, no cramps. After a month or two, no cramps," Holladay says. It was miraculous, he says, and he can't speak highly enough of the neurology department at Stanford or of Dr. So.

Keeping Spasms At Bay
Even though things eventually worked out for Holladay, that's not the case for many patients who suffer severe nighttime muscle cramps. According to UCSF neurologist Miller, older people are at greater risk for cramps simply because of their age. Nerves control muscles, and nerves just wear out.

"As we age, there are changes in both nerves and muscles. Muscles get more weak and small. And nerves undergo some decay, with the tissue becoming thin. And when that happens, the connections that the nerves make to the muscle become less secure."

And cramps occur at the place where nerves meet muscle, says Miller. When the brain sends the signal for the muscle to move, "the signal does have to cross through tiny nerve twigs, or nerve terminals." Excessive signaling, excessive irritability — which may result from thinning and weakened nerves — seems to be the generator for cramping.

At 68, Miller is a candidate for cramps himself. But he keeps them at bay, he says, by eating a banana a day and drinking lots of water. The banana provides electrolytes with its magnesium, potassium and calcium. The water provides fluid. Fluid and electrolytes, says Miller, while not proved to decrease muscle cramps, do seem to help by keeping nerve pathways healthy.

And Miller also benefits from stretching, doing weekly yoga and daily bike riding. Every day, he traverses San Francisco's hills for a total of two hours back and forth to work, "stretching my calf muscles and hamstring muscles by standing up on the pedals and stretching first one and then the other." Stretching is a tried-and-true cure for muscle cramps by pretty much any sufferer's description, says Miller, despite the lack of scientific evidence.

Medical Attention Or Been Hospitalized Because Of Wearing Trendy Shoes

LONDON, 2010 -- One in 10 women in Britain admit they've received medical attention or been hospitalized because of wearing trendy shoes, a survey indicates.

The survey of 3,000 women in Britain who wear high heels was conducted by Hotter Shoes, a British shoe manufacturer.

Nearly half of women say they have twisted their ankle because of their footwear and two-thirds admit wearing shoes that have caused them injury. The most frequently reported injuries caused by shoes were broken ankles, twisted knees, infected blisters, bunions and torn tendons.

"As a comfort shoe maker we were amazed to discover the pain and discomfort that women were prepared to endure for a pair of killer heels or an ill-fitting impulse sale bargain," Lisa McCarten of Hotter Comfort Concept Shoes says in a statement. "Nothing can ruin a day more than sore and tired feet, every person in our design and technical team works hard to ensure that our shoes are stylish and comfortable."

Advice for Hikers and Hunters: Long, Vigorous Hikes Take Toll on Feet, Ankles

As brightly colored leaves dazzle the fall landscape, hikers and hunters nationwide will migrate to mountains, woods and fields, but many, unfortunately, are ill prepared for the beating their feet will take.

Hikers, hunters and others who love the outdoors often don’t realize how strenuous it can be to withstand constant, vigorous walking on uneven terrain. Lax physical conditioning and inappropriate footwear bring scores of outdoor enthusiasts to foot specialists each fall for treatment of foot and ankle problems such as chronic heel pain, ankle sprains, Achilles tendonitis, fungal infections and severe blisters.
Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven’t conditioned properly before hitting the trail. Also, many don’t realize that cross-training athletic shoes aren’t the best choice for extended hiking and hunting. Many injuries can be avoided by wearing sturdy, well constructed hiking boots.

Hikers and hunters should investment in top-quality hiking boots. Strong, well insulated and moisture-proof boots with steel or graphite shanks offer excellent ankle and foot support that helps lessen stress and muscle fatigue to reduce injury risk. Supportive shanks decrease strain on the arch by allowing the boot to distribute impact as the foot moves forward. If a boot bends in the middle, it may not be well suited for hunting or hiking.

In wet and cold weather, wearing the right socks can help prevent blisters, fungal infections and frostbite. Synthetic socks are excellent as the first layer to keep the feet dry and reduce blister-causing friction. For the second layer, wool socks add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable. Wool lets moisture evaporate more readily than cotton, so fewer blisters develop.

What happens if your feet or ankles hurt during a hike or hunt? Pain usually occurs from overuse, even from just walking. If you’re not accustomed to walking on sloped or uneven ground, your legs and feet will get tired and cause muscles and tendons to ache. To avoid a serious injury, such as a severe ankle sprain or an Achilles tendon rupture, rest for awhile if you start hurting.

Pain is a warning sign that something is wrong. Serious injury risk escalates significantly if you continue hiking in pain. Hiking, like skiing, is an activity in which beginners should take on less difficult trails until they become better conditioned and more confident.

Evaluation by a foot and ankle specialist is recommended if there is persistent pain following a hiking or hunting outing. Ankle instability and strained Achilles tendons are most concerning. Inattention to these problems at their early stages may lead to a serious injury that will keep you off the trails for a long time.

Why Does My Achilles Tendon Hurt?

You don’t have to be an accomplished athlete to suffer Achilles tendon injuries. They can occur from performing minor household tasks, such as climbing a ladder. Achilles tendon weakness is common in adults and prompt treatment when symptoms occur can prevent more serious injury.

The Achilles tendon is the longest and strongest tendon in the body, but is subjected to considerable wear and tear. When the tendon becomes inflamed from overuse or too much sudden stress, tendonitis can weaken it over time and cause microscopic tears. Going without treatment only increases risk for further deterioration and possible rupture.

Pain, stiffness and tenderness in the area are the main symptoms of Achilles tendonitis. Pain occurs in the morning, improves with motion, but gets worse with increasing stress and activity.

In addition to athletes, Achilles tendonitis is common for anyone whose work routine puts constant stress on the feet and ankles. Achilles tendon injuries happen most often to less conditioned, “weekend warrior” athletes who overdo it.
When pain and other symptoms indicate possible Achilles tendonitis, a thorough diagnosis is necessary to determine the extent of the trauma and evaluate the flexibility and range of motion in the tendon. Treatment options depend on the extent of the injury.

They include:
• Casting to immobilize the Achilles tendon and promote healing
• Ice to reduce swelling
• Non-steroidal anti-inflammatory medication to reduce pain and inflammation
• Physical therapy to strengthen the tendon
• Surgery, if other approaches fail to restore the tendon to its normal condition

Recreational activities involving jumping and running are the major cause of Achilles tendon injuries. In sports like basketball and tennis, muscles and tendons in the back of the leg are prone to injury from an imbalance that occurs from a lot of forward motion. As a result, the frontal imbalance can weaken the tendon unless stretching exercises are performed regularly.

The best way to prevent Achilles tendon injuries is to warm up gradually by walking and stretching. Further, it’s best to avoid strenuous sprinting or hill running if you are not in shape for it.

Still Think High Heels Are Worth It?

It’s not what fashion-conscious women want to hear—another warning about high heels. But, pump-style shoes often cause significant pain by irritating a common bony deformity on the back of the heel called ‘pump bump.’ In many cases, it can lead to bursitis or Achilles tendonitis if left untreated.

Pump bump is common in young women who wear high heels almost every day, and their feet take a beating as a result. The rigid back of a pump-style shoe can create pressure that aggravates the heel bone when walking.

The bump or bony protrusion is a hereditary deformity that can cause Achilles tendonitis or bursitis due to constant irritation from pump-style shoes. Those with high arches or tight Achilles tendons are especially vulnerable to developing pump bump if they work in high heels.

The medical term for the disorder is Haglund’s deformity. In addition to the noticeable bump, symptoms include pain where the Achilles tendon attaches to the heel, swelling in the back of the heel and redness in the area.

In the majority of cases, pump bump is treated non-surgically by reducing inflammation, but this does not get rid of the bony protrusion. Pain relief is the primary treatment goal, so anti-inflammatory medications usually are prescribed. Icing the back of the heel reduces swelling, and stretching exercises can relieve tension in the Achilles. Long-term, however, it’s best to avoid wearing high heels, if possible.

When the dress code requires high heels, it is advised that women try heel lifts to decrease pressure on the heel or wear appropriate dress shoes that have soft backs or are backless.

Pain to the Bottom of the Heel Can Have Many Causes

Pain on the bottom of the heel is most often caused by plantar fasciitis. Heel pain may also be due to other causes, such as a stress fracture, arthritis, nerve irritation, or, a bone tumor or cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed.

A stress fracture to the heel bone will cause pain when walking, but the heel area may also be red, hot, swollen, and bruised.

Arthritic conditions such as rheumatoid arthritis and psoriatic arthritis not only affect the joints, but can also cause inflammation of the tendons and ligaments in the foot leading to heel pain.

There are 2 types of nerve entrapments that can cause heel pain. Tarsal Tunnel Syndrome is similar to Carpal Tunnel Syndrome. A large nerve to the inside of the foot can be compressed by large veins, a soft tissue mass, or even because of the structural changes to the foot from severe flatfoot deformity. Patients with Tarsal Tunnel Syndrome have pain to the bottom of the heel, but may also experience shooting pains along the entire bottom of the foot and numbness and tingling of the toes.

Baxter’s nerve entrapment is another cause of heel pain. Baxter’s nerve is a small nerve branch on the bottom of the foot that becomes entrapped by a muscle on the bottom of the foot. This type of heel pain is typically worsened with long activity and often radiates to the outside of the bottom of the heel.

Certain types of heel bone cysts or tumors can also cause heel pain. Bone cysts can be filled with water or blood. Fatty tumors called lipomas are common in the heel bone. Rarely, the heel bone can have a metastatic tumor.

Plantar fasciitis is an inflammation of the band of tissue that extends from the heel to the toes. Plantar fasciitis generally results in pain to the heel after any period of rest and with long activity.

A thorough history and physical exam is necessary to properly diagnose heel pain. X-rays, diagnostic ultrasound, MRI, CT scans, or nerve studies may be necessary as well.

If you have pain to the bottom of your heel, call Central Kansas Podiatry Associates for further evaluation.