Unique, Not Psychogenic Movements: Painful Leg and Moving Toes Syndrome

A 74-year-old woman visited our department for distally predominant unpleasant pain in the bilateral feet for several months. She had a history of chronic lumbago. Neurological examinations showed normal findings other than involuntary movements. A nerve conduction study, electroencephalography, and brain MRI revealed unremarkable findings, while spinal MRI revealed mild lumbar spinal stenosis. Given the typical unique movements, i.e., bilateral toe movements, which are asynchronous and consist of extension, flexion, and, rarely, abduction, she was diagnosed with painful leg moving toes syndrome. Administration of duloxetine produced partial pain relief and reduced movements. We considered that clinicians should be aware of this unique movement disorder in order to avoid misdiagnosis with psychogenic conditions.