For some people, ALS starts in the lower limbs.

Possible early signs include:

* Difficulty lifting the front of the foot
* Repeatedly catching the toes while walking
* An ankle that feels unusually weak
* Increasing difficulty climbing stairs

Mayo Clinic lists weakness in the legs, feet, or ankles among common early presentations. ([Mayo Clinic][1])

## 3. Frequent Tripping or Falling

Unexplained trips and falls can occur when leg or foot muscles become weaker.

Someone who previously walked normally may begin:

* Stumbling on flat surfaces
* Catching a foot on rugs or steps
* Losing balance more often
* Having trouble with routine walking

ALS is only one of many possible causes of frequent falls. Joint problems, medications, vision changes, inner-ear disorders, peripheral neuropathy, and other neurological conditions can cause similar symptoms. ([Mayo Clinic][1])

## 4. Muscle Twitching

Small involuntary muscle twitches, known as **fasciculations**, are commonly associated with ALS.

They may occur in areas such as the:

* Arms
* Shoulders
* Legs
* Tongue

However, muscle twitching is extremely common and can also happen because of exercise, stress, caffeine, sleep deprivation, or other benign causes.

Twitching becomes more meaningful when it occurs alongside **progressive muscle weakness or wasting**. ([Mayo Clinic][1])

## 5. Muscle Cramps