Most Leg Cramps are Harmless, But Some Have a Deeper Cause

June 09, 2022
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Leg cramps are a common annoyance that most everyone experiences at some point in their life. For some people, painful leg cramps (often called charley horses) can disrupt their sleep (according to the Sleep Foundation, about 60% of people report experiencing leg cramps at night). Whether you have leg cramps during the day or night, leg cramps can often be treated with exercise (both during cramping episodes and during the day to prevent them). 

How to Stop Leg Cramps

You may get relief from massaging and stretching your cramped muscle. Experts also recommend applying heat or cold in the form of a warm towel or heating pad – or massaging the muscle with an ice pack.

Make an appointment with your doctor if your leg cramps are not getting better. 

What Causes Leg Cramps?

Leg muscle cramps often happen for no known reason. These cramps may be caused by stress, not stressing enough, overworking your muscles, or not drinking enough water.

Although most muscle cramps are harmless, some may be related to an underlying medical condition known as peripheral arterial disease (PAD), a form of peripheral vascular disease (PVD).


While only one letter separates the abbreviations for these conditions, a great many blood vessels differentiate PVD from PAD. The key thing to understand is that PAD is a form of PVD. Here’s how that works:

As its name suggests, peripheral vascular disease affects all types of blood vessels including arteries, veins, and lymphatic vessels. PVD is an “umbrella term” that encompasses several slow, progressive circulatory diseases caused by the narrowing of, blockage in, or spasms in blood vessels.

Meanwhile, as its name suggests, peripheral arterial disease only affects arteries, most often the arteries of the legs. Left untreated, PAD can lead to lack of oxygen to the downstream organ causing limb loss, heart attack, or stroke.

PAD Facts and Symptoms

According to Dr. Stuart Blackwood, vascular surgeon at Baystate Health, “200 million people worldwide have PAD, and 95% of those have no symptoms and are often unaware they have the condition. When symptoms begin to appear, they’re often attributed to aging or other things which can complicate and delay diagnosis.”

If you have lower limb PAD, symptoms typically occur in your legs and feet. Blackwood explains, “Fatty deposits in the arteries that carry blood to the legs and feet keep oxygen and nutrients from reaching tissue in those areas. While symptoms may appear to come on suddenly, the condition has often been developing for years.”

Among the most common symptoms of PAD are:

  • Pain in the calf, buttocks, thighs
  • Numbness or weakness in the legs
  • Hair loss on legs or feet
  • Thickening toenails
  • Changing skin color on legs or feet (sometimes pale, red or blue)
  • Shiny skin on legs or feet
  • Slow- or non-healing wounds on feet and legs
  • Erectile dysfunction
  • Muscles shrinking (atrophy) in legs
  • Weak pulse the feet or legs

Blackwood notes, “It’s important to realize that any one of these symptoms on their own doesn’t necessarily point to PAD. You need to look at the constellation of symptoms to determine what’s really contributing to your condition.”

A Closer Look at Leg Muscle Cramps and PAD

The most common symptom of lower-extremity PAD, painful muscle cramps in calf, buttocks, thighs, or hips, is called claudication

“Claudication occurs when your body can’t deliver the oxygen needed by your muscles to engage in an activity, most often walking,” explains Blackwood. “You can readily identify a PAD cramp from, say, a Charlie horse by the fact it goes away when you stop the activity; often immediately, sometimes after a few minutes. But if you re-engage, the pain will recur. Depending upon the severity of the PAD, the pain may be mildly discomforting or full-on debilitating.”

Blackwood notes, “It’s important not to ignore cramping pain that repeatedly occurs when walking. The pain is your body sending a warning that something is amiss, and that part of your body isn’t receiving enough blood during.”

Risk Factors for PAD

Of the numerous risk factors for PAD (see below), Blackwood emphasizes that smoking is the most important one. In fact, he says, the risk of smokers and former smokers developing PAD is 2.5x higher than it is for non-smokers.

Both men and women are at risk of developing peripheral arterial disease when they have one or more of the following risk factors:

  • Smoking
  • Age 50+
  • Diabetic, especially those with long-term insulin dependence
  • Chronic kidney disease
  • Experienced a heart attack 
  • Family history of PVD
  • High blood pressure 
  • High cholesterol
  • Blood clotting disorder

Treatment for Leg Cramps and PAD

The goal of treating PAD is two-fold:

  1. Managing symptoms, such as leg pain, so you can continue with normal physical activities
  2. Stopping the progression of PAD and PVD throughout your body to reduce your risk of heart attack and stroke

Blackwood says, “The good news is you may be able to achieve these goals with simple lifestyle changes, especially if it’s caught early.” He adds, “If you smoke, quit. This is the single most important thing you can do to reduce your risk of complications, including limb loss.”

Beyond that, Blackwood says embracing healthy eating habits and being physically active for 20-30 minutes a day can both work to improve your overall circulation and reduce your risk for complications.

“Baystate offers a Supervised Exercise Therapy program for people with PVD,” says Blackwood. “You work one-on-one with a nurse and exercises physiologists for 36 sessions to improve your walking distance and get you back to living a full life. It’s easy to enroll and is just as effective as some surgical interventions but without the risks.” Contact the Baystate Heart & Vascular Program at 412-794-CARE (2273) to learn more.

In some cases, medications for blood pressure control, cholesterol and blood thinners may be prescribed.

In even fewer (4%) and very severe cases, surgery may be needed. Blackwood says, “The goal always is to avoid surgery. This is true for a couple of reasons. First, the long-term outcome of treating PAD with exercise and diet is typically better than, say, a stent. Second, once you have a surgical procedure, you’re more likely to require repeat procedures to address the condition.”

For the 4% who become so symptomatic that surgery is required, the most common options are angioplasty, stenting, and, less often, surgical bypass in the affected area.

However, he notes that 98% of PAD patients can successfully live with the condition without surgery. The remaining 2%, who represent the most severe case, typically require amputation of the foot.

There’s More to PAD Than Leg Cramps

If you have trouble with your feet or legs, talk to a doctor about PAD. In addition to the pain and potential limb loss related to PAD, people with PAD have an increased risk of coronary artery disease, stroke and heart attack. Early detection is key. Speak to your doctor if you have any concerns about yourself and encourage friends and loved ones exhibiting symptoms to do the same.

Contact the Baystate Heart & Vascular Program at 413-794-CARE (2273) to learn more.

Leg Cramping & PVD

Stuart Blackwood, MD and Amanda Methe RT break down leg cramp causes and signs and treatments for PAD.

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