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Are lower limb biomechanical factors associated with night-time calf cramps in adults? A case-control study


Night-time calf muscle cramps are highly prevalent and are associated with reduced quality of sleep and health-related quality of life [1]. The underlying mechanism is poorly understood and no treatment has shown consistent efficacy or safety. The aim of this study was to identify factors associated with night-time calf cramping in adults to explore potential underlying mechanisms and therapeutic targets.


160 adults were recruited the Greater Newcastle and Central Coast regions of New South Wales, Australia: 80 who experienced night-time calf cramp at least once per week and 80 age- and sex-matched adults who never experienced lower limb muscle cramping. Participants were assessed using reliable tests of foot/ankle and toe strength, range of ankle dorsiflexion, hamstring flexibility, foot alignment, and calf circumference. Participants also completed a bespoke survey examining health and lifestyle factors, exercise, lower limb symptoms and footwear characteristics.


Presence of night-time calf cramps was significantly correlated with weakness of foot and ankle inversion, eversion, dorsiflexion and plantarflexion; weakness of toe grip; restricted hamstring flexibility; lower limb tingling sensations; muscle twitching, and coldness of legs or feet in bed at night. Conditional logistic regression identified three factors independently associated with night-time calf cramps: muscle twitching (OR 4.6; 95%CI: 1.6 to 15.5; p=0.01), lower limb tingling (OR 4.1; 95%CI: 1.6 to 10.3; p=0.003) and foot dorsiflexion weakness (OR 1.02; 95%CI: 1.01 to 1.03; p=0.002), which represented other measures of lower limb weakness in the model.


Night-time calf muscle cramps were associated with markers of neurological dysfunction and potential musculoskeletal therapeutic targets.


  1. Hawke F, Chuter V, Burns J: Impact of nocturnal calf cramping on quality of sleep and health-related quality of life. Qual Life Res. 2013, 1281-1286. 22

  2. Gulich M, Heil P, Zeitler H-P: Epidemiology and determinants of nocturnal calf cramps. Eur J Gen Pract. 1998, 4: 109-13. 10.3109/13814789809160361.

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Correspondence to Fiona Hawke.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Hawke, F., Chuter, V. & Burns, J. Are lower limb biomechanical factors associated with night-time calf cramps in adults? A case-control study. J Foot Ankle Res 7 (Suppl 1), A31 (2014).

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