> Dear Marguerite:

I write the newsletter for the Parkinson Foundation of Harris County in
Houston, Texasand just had an article regarding cramping plus some
exercises. The following is a copy.
The pictures didn't print, but hope this can be of some help for your
mother.

                                            FOOT CRAMPS
                                               Nina Brown

     Cramping can result from innumerable causes, but it is one of the
multitude of ways that the rigidity encountered with Parkinson’s disease is
manifest. Rigid muscles are in a constant state of contraction. When you
experience a contraction in your neck, you get a headache.  If that
contraction or spasm is in your foot or leg, you get a cramp.  If you’ve
ever had your toes bend in a claw-like position inside a tight shoe or
watched your foot turn inward, then you’ll know this annoying symptom can
also be a “pain in the neck!”  So we need to understand why we get cramps
and what we can do about them.

 Muscle cramping can precede the onset of other symptoms by years and may
have been your first symptom of Parkinson’s disease.  It appears to be more
common in the young onset and usually occurs in the leg where Parkinson
symptoms were first noticed.

 Foot cramping is just one of several dystonias (abnormal, sustained
tightening of muscles) that occur when the brain gets either too much
dopamine (a peak-dose dystonia) or too little dopamine (a wearing-off
effect).

 Cramping can occur throughout the day or night.  When you reach a peak drug
level an hour or two after taking Sinemet or when the effect of the drug
wears off, changing the dose or dosage schedule or using Sinemet CR may
help, as may the monoamine oxidase B inhibitor, selegiline (Eldepryl).
Cramping can be especially annoying when it interferes with your sleep.  A
bedtime dose of Sinemet CR, or adding a dopamine agonist, may also help
prevent foot dystonia during the early-morning hours.

 Other treatments include Quinine, anticholinergics such as Artane, muscle
relaxants such as Flexeril and Lioresal and the anticonvulsant, Klonopin.  A
treatment that seems to give some relief is the injection of botulinum toxin
(Botox) which reduces the intensity of the spasms by “paralyzing” the muscle
for months after the treatment.

 With all of that in mind, a discussion with your physician might be your
next step toward solving the problem.   If you prefer trying some
non-prescription remedies, some people have reported getting relief from
taking Vitamin E.  Another potential benefit from taking Vitamin E may be
the neuroprotective effect that numerous studies have focused upon because
of its antioxidant properties.

 Fosfree, a dietary supplement with calcium, iron and vitamins, has also
been recommended.
 I find that pulling my foot inward toward me will relieve a calf cramp.

 The best solution to the problem might be the simplest. Apply heat from a
hot water bottle or heating pad after gently massaging your foot or calf
muscles.
 As you massage your feet, you might also consider the technique of
reflexology, which dates back to ancient China 4000 or more years ago.  The
practice of reflexology divides the soles of the feet and hands into
sections that mirror the different internal body organs and uses massage to
heal, stimulate and strengthen these areas.  Reflexology charts show that
the ends of the toes are the connection to the brain.

 Considering how much we depend upon our feet and how much they do for us,
it’s only fair that we should pamper them a little.  We often put them in
poor-fitting shoes and still expect them to bear our body weight and take us
where we want to go.  So after we review some exercises to keep your feet in
shape, we’ll learn new special massage techniques.  Your feet have thousands
of nerve endings so a good foot massage, not only feels wonderful, but is
also especially effective in relieving stress and tension.

                                         EXERCISES

1.  Toe raise, toe point, toe curl.  Hold each position for five seconds and
repeat 10 times. This helps cramps and hammertoes as well.

2.  Toe squeeze.  Place small corks between your toes and squeeze for five
seconds. Repeat 10 times.  This one is also good for hammertoes or toe
cramps.

3.  Marble pickup.  Place 20 marbles on the floor.  Pick up one at a time
with your toes and put each marble in a small bowl.  This is recommended for
people who have pain in the ball of the foot, toe cramps or hammertoes.

4.  The golf ball roll.  Roll a golf ball under the ball of your foot for
two minutes.  This is a great massage for the bottom of the foot and arch
strain as well as cramps.

5.  Towel curls.  Place a small towel on the floor and curl it toward you,
using only your toes.  You can increase the resistance by putting a weight
on the end of the towel. Relax, then repeat this exercise five times. This
one also helps with any pain in the ball of your foot and over-all
strengthening.

6.  Big toe pulls. Place a thick rubber band around both big toes and pull
them away from each other, toward the small toes. Hold for five seconds and
repeat 10 times.

7.  Toe pulls.  Put a thick rubber band around all of your toes and spread
them.  Hold for five seconds and repeat 10 times.

                           FOOT MASSAGE

 Geri Haynes, a teacher of martial arts, has shared some of the foot massage
techniques she teaches.  The directions below are for the left foot.  You
should do the same exercises for the right foot.
 1.  With your socks on, place the right hand on the left foot.  Your palm
should be in contact with the foot continually.  The hand should exert
pressure on the foot, but the arm should be relaxed.  The thumb should be on
the arch side of the foot.  The little finger on the outside of the sole.
 2.  Pull back on the toes with the left hand.  Find the tendon in the arch
of the left foot with the right hand.  Strum the tendon with the thumb of
the right hand.
 3.  With your thumb and index finger, massage the outside rim of the foot
from the heel to your little toe.
 4.  With the right hand, clasp the fingers at the base of the toes on the
left foot and with the heel of the palm, massage the instep with the heel of
the palm while at the same time pressing the finger tips into the base of
the toes.
 5. With the thumb and index finger, massage the Achilles tendon with a
stroke strong enough to feel like you are pressing the fingers together.
 6.  With a soft semi-closed fist, rap short staccato strikes on the entire
surface of the sole.
 7. Clasp the toes and draw circles with the foot.  This exercises the ankle
joint.  Rotate clock and counter-clock wise.
 8.  Pull back on the left foot and at the same time, straighten the leg
upward to exercise the knee.
 9.   Splay foot on floor.  With the back on your knuckles, rub the top of
the left foot.
 10.  Make circles around the ankle with the thumb pads of both hands
together.


> --

Nina P. Brown
Phone: 713.729.1544
Fax:     713.610.8662