Continuous Movement of the Toes

By Khizar Malik, MD; Cara Sherrill; and Fabian Rossi, MD Section Editor: Aziz Shaibani, MD

In this case, we present a 26-year-old African American male with an 18-month history of constant involuntary alternating dorsiflexion-plantar flexion movements of his left toes, especially the big toe. With manual interference and conscious attention, he could eliminate the movement. He had dull pain in the left lower extremity, but no urge to move his left foot or toes. 

The patient had a temporary response to a dopamine agent that lasted one month. Neurological examination revealed a decreased light touch sensation on his feet, otherwise unremarkable. Results from MRI of the brain and spine, EEG, nerve conduction studies, and electromyography were normal. Other test results were unremarkable, as was family history.

The most likely diagnosis is:

1. Epilepsy partialis continua

2. Restless leg syndrome

3. Akathisia

4. Painful legs and moving toes syndrome

5. Spinal segmental myoclonus

6. Chorea

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Launched in 2002, Practical Neurology is a publication uniquely dedicated to presenting current approaches to patient management, synthesis of emerging research and data, and analysis of industry news with a goal to facilitate practical application and improved clinical practice for all neurologists. Our straightforward articles give neurologists tools they can immediately put into practice.