People get more worried if the whole toe “jumps” or jerks vs. just feeling a twitch without seeing it.

ALS will come to mind in those suffering from health anxiety or even those who’ve just come across basic information about amyotrophic lateral sclerosis.

The visual experience of seeing the entire toe jump from an involuntary muscle twitch can be quite alarming to people who are familiar with the symptom list of ALS.

A fasciculation is a type of involuntary muscle twitch. Typically, the sensation feels like a worm wiggling beneath the skin.

Muscles DO Twitch from ALS

Keep in mind that the word “twitch” is rather ambiguous, and isn’t even a medical term.

It’s a subjective description by the patient, and may not even be what the patient would call a jerking or tremoring motion, but instead, described as a “creepy crawly” feeling.

“ALS involves muscle fasciculations in a variety of areas in combination with progressive weakness,” explains Mitzi J. Williams, MD, clinical neurologist with Morehouse School of Medicine and clinical advisor for the Multiple Sclerosis Foundation.

“The fasciculations can be seen in the muscle, but do not necessarily make the whole part of the extremity (fingers or toes) move.

“Toe twitching in isolation does not equal a diagnosis of ALS.

“If you have frequent muscle twitching, it would be useful to be seen by your physician to make sure there are no electrolyte abnormalities that may be causing this, and if further investigation is needed, you can be referred to a neurologist.”

What It Means when the Whole Toe Twitches

There are a few ways to look at this. First off, suppose you’ve been having this symptom for a very long time.

And there are no other symptoms like weakness, a floppy foot, increasing numbness, etc.

And by chance or curiosity, you decided to pursue information about this – and came upon a few ALS sites.

You must realize that if even the entire toe has been twitching for a very long time in the absence of other symptoms, you should not go to sleep worried sick over a motor neuron disease.

The key variables are:

• A lot of time behind the toe twitching

• No other symptoms that sound like ALS such as foot drop

• The occurrences are associated with the time period soon after heavy exercise involving the feet such as trail running.

Secondly, the fact that you can see or feel the entire toe actually move is not predictive of the likelihood of ALS or other motor neuron disease.

The reason you see the whole toe twitch is because the toe is a small unit of the body.

The muscle fibers that are involuntarily firing are very small and within a small space.

This concept is also why you not only feel an eyelid twitch, but you can easily see this as well.

But when a muscle twitch occurs in a large area such as the thigh or calf, it does not cause the entire leg to jump.

You may see the fasciculation under the skin, but it doesn’t make the limb jerk – because the limb is just too big.

Though a limb may jerk just as you’re falling asleep (myoclonus), this is not the type of “twitching” being discussed here.

In short, the chief points to consider are:

• Presence or absence of other symptoms especially progressive weakness

• Visible jerking of the toe vs. non-jerking is not indicative of the probability of ALS.

• Associated activities that precede the twitching such as jumping exercise or running.

Mitzi Williams, MD

Dr. Williams is author of “MS Made Simple: The Essential Guide to Understanding Your Multiple Sclerosis Diagnosis.” She is a member of the American Academy of Neurology.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


­Top image: ©Lorra Garrick