Patients with amyotrophic lateral sclerosis (ALS) may experience leg pain, but leg pain is not the primary clinical manifestation of ALS. The early main symptoms of ALS include muscle atrophy and limb weakness. As the disease progresses, patients will further experience general muscle atrophy and weakness, which may manifest as difficulty in swallowing, speech problems, and respiratory difficulties. As the disease progresses, if the patient experiences extreme muscle atrophy and limb weakness, they may experience leg pain during movement, but this symptom is not specific. Therefore, when symptoms such as muscle atrophy and limb weakness occur, the possibility of ALS should be considered, and patients need to undergo timely examinations such as electromyography and muscle biopsy to confirm the diagnosis. If the patient also suffers from leg pain, other conditions such as sciatica and osteoporosis should be considered, and further examinations like bone density tests and lumbar disc magnetic resonance imaging should be conducted to clarify the diagnosis.