A Case of Painful Legs and Moving Toes Syndrome Mimicking Restless Legs Syndrome

Painful legs and moving toes syndrome (PLMT) is a neurological disorder characterized by leg pain accompanied by involuntary toe movements. It may be misdiagnosed as restless legs syndrome (RLS) due to overlapping clinical features. We report the case of a 69-year-old woman with a seven-year history of pain involving all toes of both feet that improved with standing or walking and worsened when lying down. She had no sleep disturbance and was unaware of involuntary movements. A trial of dopamine agonist therapy was ineffective. Careful observation revealed involuntary toe movements, supporting a clinical diagnosis of PLMT. Neuroimaging revealed lumbosacral lesions, but no findings clearly explained her symptoms, and nerve conduction studies showed no evidence of peripheral neuropathy. This case highlights the importance of observing the patient's feet over a prolonged period and considering PLMT in patients with chronic leg pain that is exacerbated at rest but lacks typical RLS features.