Question Title: Fasciculation on the top, side (top, right quadrant) of one foot.

I have what appear to be periodic muscle twitches or fasciculations on the top of my foot, to the right of midline, and occasionally extending up near the middle toes. My feet are very vascular and it's hard to tell if these are muscles, blood vessels, or something else entirely. I saw my neurologist about them five months ago (he's an MS specialist; don't know how much he knows about fasciculations and ALS) and he saw them but said he wasn't even sure that the notion of muscle fasciculation in this area corresponded to the anatomy. There are lots of (complicating) and potential explanations I guess... I had a Schwannoma removed from the same leg (hamstring, bug sucker right in the middle of the muscle) about four years ago. I also suffer occasionally but not recently from PROFOUND sciatic pain in that same leg which extends from my buttocks right into my foot. Haven't had that in a while. And I had neck surgery several months ago. My neurologist says to ignore these and to worry about something else but I've never seen anyone else with these. I occasionally see a very, very limited version of the same thing on my other foot but they're rare, hard to reproduce, and don't last long. The one's on my right foot can best be "provoked" by positioning my foot in a certain way (elevated, turned to the side)and they stop immediately with any tension on the foot. There doesn't appear to be any loss of strength or mobility and there's no cramping of any type. My neuro says skip the EMG because he doesn't even know what muscle we'd be testing and also because any EMG in my leg is likely to turn up some abnormality from the Schwannoma and/or sciatica anyway which would only freak me out more. What can I do to stop worrying about this? He's a good neurologist (fine reputation) but I don't believe he's taking my anxiety seriously enough -- wants to give me an anti-anxiety medication. If the stupid twitching would stop, I wouldn't need any! Help, please...

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Dear Wayne:

My guess is that you have benign fasciculations in the foot muscles. Such twitching in the foot muscle is very common; in fact, the majority of normal individuals have such fasciculations off and on. Some individuals are more perceptive of such fasciculations and tend to get worried about them and report them. I would probably agree with your neurologist's opinion on the basis of the information available.

For your own satisfaction and peace of mind, however, I suggest that you seek a second opinion from a neuromuscular expert at a major academic institution near you.

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