Botulinum toxin as an effective treatment for persistent twitching in first toe: a detailed case study

Abstract

Continuous fasciculation that occurs without weakness is referred to as benign fasciculation. Although generally considered non-threatening, cases that persist can significantly impact an individual's quality of life. This study presents a case of a male patient in his 30s experiencing unyielding twitching localized to the sole of his left foot for 2 years. His medical history was devoid of any notable neuromuscular diseases. Results from electromyography testing were also normal for all parameters. Attempts with pharmacological intervention did not yield any improvement of his condition. Although a nerve block targeting the left tibial nerve managed to reduce the severity of the twitching, it failed to decrease its frequency or provide a lasting solution. In search of a more effective treatment, botulinum toxin was administered via ultrasound guidance into the flexor hallucis and digitorum longus muscles. This approach resulted in a marked reduction in both the frequency and severity of the twitching, enabling the patient to resume his daily activities and achieve restful sleep without experiencing any adverse effects. Through this case, the efficacy of botulinum toxin injections as a treatment for intractable twitching is underscored, offering valuable insights into potential therapeutic strategies for similar clinical presentations.

Keywords: Botulinum toxin; Muscle; fasciculation; skeletal.

Figure 1.

Involuntary flexion of the left large toe and continuous twitching of the muscles in the sole of the foot are observed visually in a male patient in his 30s who presented with a 2-year history of persistent, involuntary twitching localized to the left sole. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 2.

Ultrasound examination of the medial side of the thigh in a male patient in his 30s who presented with a 2-year history of persistent, involuntary twitching localized to the left sole. A, soleus muscle; B, posterior tibial artery; C, flexor digitorum longus muscle.

Figure 3.

Lumbar spine magnetic resonance images showing disc protrusion at the L4–L5 and L5–S1 levels in a male patient in his 30s who presented with a 2-year history of persistent, involuntary twitching localized to the left sole.

Figure 4.

Ultrasound guided botulinum toxin injection to the flexor digitorum longus muscle in a male patient in his 30s who presented with a 2-year history of persistent, involuntary twitching localized to the left sole. A, soleus muscle; B, posterior tibial artery; C, flexor digitorum longus muscle; arrow, needle in the flexor digitorum longus muscle.