Painless legs and moving toes syndrome is a rare movement disorder characterized by semi-continuous, involuntary toe movements without associated pain. This report describes a 48-year-old woman with the condition in the context of chronic neuroleptic use. Her symptoms initially presented in one foot and later progressed to both, causing painful calluses. Treatment with benztropine alleviated her toe movements but induced orofacial dyskinesias, while amantadine caused truncal dyskinesias. The discontinuation of aripiprazole and initiation of clonazepam eventually improved her symptoms.

The syndrome’s pathophysiology remains unclear, though it may involve altered sensory afferent pathways leading to abnormal motor efferent activity. Diagnosis is clinical, and treatment often involves trial-and-error combinations of medications such as clonazepam, baclofen, and gabapentin. Due to its rarity, there are no established treatment guidelines, but this case highlights the importance of individualized therapeutic approaches and careful management of associated movement disorders.

Reference: Nagarajan E, Digala LP, Bollu PC. Painless Legs and Moving Toes Presenting as a Tardive Phenomenon: Case Report and Review of the Literature. J Neurosci Rural Pract. 2020;11(2):341-342. doi: 10.1055/s-0040-1709267.