How can I get rid of the cramps in my feet?

Here is My Question:
I’ve recently started getting cramps in my feet. At first the weren’t bad but now it feels like someone crushing my foot. I’m on a mild muscle relaxer but it works a little.

Answer:
For the purpose of answering this question I will assume you have Multiple Sclerosis and no other problems associated with either cramps or spasms.
There are three basic principles to follow for relieving muscle spasms in particular muscle groups.

1. Make sure there is no noxious stimuli ( source of pain) causing or worsening the spasms. Often people are not aware of the source of pain because of the lack of sensation in the affected body part. This is particularly true of the feet. We see individuals with serious infections or fractures that they were not aware of because of their lack of adequate sensation.
2. Make sure you are stretching the involved muscle regularly and avoiding positions that provoke spasms if possible. You can find stretching regimens on-line or see a physical therapist for a stretching program individualized for your needs. Leg spasms are often worse when lying down at night to sleep. Certain positions of the feet may provoke spasms. Finding ways to avoid these positions can be helpful
3. Use anti-spasticity medications appropriately to decrease the spasms. I often find that anti-spasticity medications are prescribed according to the package insert instead of your individual needs. For instance, the package insert will tell you to take Baclofen (a common anti-spasticity medication) three times a day, but this is often not necessary. Daytime doses can increase drowsiness and mental fogginess and decrease your balance unnecessarily if you only need the baclofen to limit evening or nocturnal spasms  that interfere with sleep. If your problems with spasms are mostly at night and you can manage the spasms during the day with stretching and movement, only take baclofen in the evening and use enough to accomplish your goal. Some people do very well with a dose of 20 to 30 mg taken just in the evening as one dose. If baclofen doesn't work at an acceptable and tolerated dose given at the right time of day, move on to other medications until you find one that works. It helps to try medications with different mechanisms of action ; a common sequence is baclofen, then gabapentin then tizanidine then a benzodiazepine (e.g. diazepam). This assumes you have already tried standard muscle relaxants like cyclobenzaprine. If the spasms involve a particular group of muscles in the feet, botox can be effective in refractory cases.

Good luck

Revere P (Rip) Kinkel, MDProfessor of Neurosciences
Director of the Multiple Sclerosis Program
University of California San Diego
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