The case of a 49-year-old man with involuntary toe movements

A 49-year-old man presented with 3 years of leg pain and involuntary toe movements. He described the pain as mild burning, radiating from the left foot upward to the leg. On examination, there were involuntary continuous flexion-extension movements of his left toes (video). Strength, sensation, and reflexes were normal. Lumbosacral MRI demonstrated diffuse degenerative disc disease with multi-level mild-to-moderate foraminal stenosis. Nerve conduction studies were normal. EMG showed neurogenic potentials and active denervation changes in the left anterior tibial and soleus muscles consistent with radiculopathy. The diagnosis of painful legs and moving toes is discussed.