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The suggestions I have had so far are: 1. Increase the dose of amitryptiline and/or decrease the dose of Sinemet. 2. Exercise....a weak muscle cramps more than a strong muscle does. 3. An orthotic device in my shoe on that side. 4. Stretching exercises before bedtime. Since I started going to physiotherapy and using a cane so that I don't re-injure my knee, there has been less knee pain. The muscle still cramps in the evening mostly and my foot still twists. I think the first time I ever had problems with my leg jumping or twitching at night was when I was pregnant for the first time (that is about 30 years ago). In the past few years, it has become worse.