Painful Legs and Moving Toes Syndrome:
Unusual condition that presents with acute onset (usually) of a constant, deep, throbbing and severe burning/aching pain of one affected leg and/or foot with spontaneous involuntary foot movements (mainly the toes flexion-extension and abduction-adduction). Can be painful. Movements tend to persist during sleep may cause insomnia. Patient can usually stop the movements voluntarily for up to a minute. Can vary from a mild to severe affect on patients daily activities. Case has been reported of the initial symptoms mimicking Morton’s interdigital neuroma .
Usually have no sensory loss. EMG shows two different patterns:
1) Rhythmic bursts of high amplitude complex motor discharges
2) Erratic continuous low amplitude activity
May be linked to impairment of spinal serotonin and GABA functions as some patients have been reported as responding to clonazepam and baclofen. Adenosine deficiency in blood has been reported in two cases . Ephaptic transmission in damaged nerve roots or peripheral nerves with central reorganisation has also been suggested as the underlying mechanism of the syndrome
May have history of lumbosacral radiculopathy or other lesion of the spinal cord, peripheral neuropathy or bony/soft tissue injury to the feet.
Generally responds poorly to pharmacological intervention; anticonvulsant medication (eg dilantin) may help some – also baclofen (possibly in combination with clonazepam); brace at night to limit foot plantarflexion (may help sleep); use of TENS with vibratory stimulation has also been suggested ; sympathetic and epidural nerve blocks have helped some