Abstract
Painful legs and moving toes (PLMT) is a very uncommon disorder in which patients experience pain in their legs together with continuous involuntary movements of their toes. Pain is usually the first and predominant symptom. The pain is typically deeply seated and is usually described as a severe aching, pulling, or crushing sensation in the lower legs. Persistent toe movements may not be reported but are evident on examination and consist of flexion-extension or abduction-adduction fanning movements with a frequency of 1–2 Hz. In severe cases, more proximal leg movements may also be present. Patients can usually suppress the toe movements for short periods of time, but they typically promptly return within moments.
Keywords
- Peripheral Neuropathy
- Botulinum Toxin
- Complex Regional Pain Syndrome
- Botulinum Toxin Injection
- Extremity Injury
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This chapter contains a video segment which can be found at the URL: https://doi.org/10.1007/978-1-60327-426-5_80
Background
Painful legs and moving toes (PLMT) is a very uncommon disorder in which patients experience pain in their legs together with continuous involuntary movements of their toes. Pain is usually the first and predominant symptom. The pain is typically deeply seated and is usually described as a severe aching, pulling, or crushing sensation in the lower legs. Persistent toe movements may not be reported but are evident on examination and consist of flexion-extension or abduction-adduction fanning movements with a frequency of 1–2 Hz. In severe cases, more proximal leg movements may also be present. Patients can usually suppress the toe movements for short periods of time, but they typically promptly return within moments. Symptoms are usually bilateral but may occasionally present unilaterally. Much less common variants of PLMT have been reported such as painful hand and moving fingers and painless legs and moving toes. In most cases, symptoms appear on a background of lumbosacral radiculopathy, peripheral neuropathy, or lower extremity injury which, together with the character of the pain, suggests that PLMT may be a variant of complex regional pain syndrome. PLMT is often mistaken for restless legs syndrome but differs in that the toe movements are involuntary while in restless legs syndrome any associated leg movements are voluntary attempts to relieve leg discomfort. Response to various treatments has been variable but usually disappointing and has included sympathetic blockade, guanethidine blocks, transcutaneous nerve stimulation, anticonvulsants, and antidepressants.
Case
A 63-year-old woman experienced pain and hypersensitivity to touch of both feet followed within several months by involuntary movements of her toes present only when seated or lying down. This occurred on a background of type 2 diabetes and liver cirrhosis. Symptoms persisted for the next 4 years. Examination showed continuous flexion-extension movements of the toes while standing, seated, or reclining. Vibration, position, and light touch were reduced in the feet but there was no allodynia. Ankle reflexes were absent. Pain was reasonably well controlled on a combination of gabapentin and duloxetine, but disturbing toe movements persisted unchanged without response to clonazepam or botulinum toxin injections into the flexors and extensors of the toes.
References
Spillane JD, Nathan PW, Kelly RE, Marsden CD. Painful legs and moving toes. Brain. 1971;94:541–56.
Dressler D, Thompson PD, Gledhill RF, Marsden CD. The syndrome of painful legs and moving toes. Mov Disord. 1994;9:13–21.
Alvarez MV, Driver-Dunckley E, Caviness JN, et al. Case series of painful legs and moving toes: clinical and electrophysiological observations. Mov Disord. 2008;23:2062–6.
Author information
Authors and Affiliations
Electronic Supplementary material
While reclining, the patient displays continuous flexion-extension movements of the toes.
Painful Legs & Moving Toes.mp4 (MP4 4,335KB)
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media New York
About this chapter
Cite this chapter
Bhidayasiri, R., Tarsy, D. (2012). Painful Legs and Moving Toes. In: Movement Disorders: A Video Atlas. Current Clinical Neurology. Humana, Totowa, NJ. https://doi.org/10.1007/978-1-60327-426-5_80
Download citation
DOI: https://doi.org/10.1007/978-1-60327-426-5_80
Published:
Publisher Name: Humana, Totowa, NJ
Print ISBN: 978-1-60327-425-8
Online ISBN: 978-1-60327-426-5
eBook Packages: MedicineMedicine (R0)