a 24-year - old female had noticed involuntary movements in the right toes since the age of 12 . the involuntary movements of her right toes began insidiously , worsened until the age of 18 , and plateaued thereafter . the movements did not interfere with her daily activities , and she was not receiving any medications . there was no clinical history of trauma or family history of such movements . on examination the movements were 1 - 1.5 hz , semirhythmic , and multidirectional ( side - to - side / adduction / flexion and extension / intorsion ) , with a sinusoidal , writhing , and wriggling appearance . they were nearly continuous , and intermittently increased in amplitude . even though they could not be suppressed completely , they fluctuated in amplitude with postural changes and distant muscle contraction such as repetitive hand - gripping . the movements were mainly observed in the right toes , but similar movements appeared in the left toes intermittently , which had not been previously appreciated by the patient . on electromyography , giant motor unit potentials were present in the s1 myotome of the right medial gastrocnemius . mri of the lumbosacral spine showed mild protrusion and signal changes at the l5-s1 intervertebral disc ( fig . ) . her involuntary movements included activity of the s1 myotome , which is affected by radiculopathy . the involuntary movements appeared bilaterally in the toes in our patient , which suggests that central reorganization ( especially in the spinal level ) is the cause of polmt , as it is in plmt.11 after nerve injury , functional deficits may be compensated for by plasticity of the central nervous system . however , such plasticity is not perfect , and may result in maladaptive changes such as involuntary movements.12 bilateral involvement has also been reported in plmt associated with unilateral lesions.1 - 5 the alterations in the amplitudes of toe movements in our patient by postural changes and distant muscle contractions also supports a central pathomechanism .
this is the first report of a case of painless moving toes syndrome with radiculopathy . 
 the patient presented with bilateral painless moving toes and unilateral subclinical sacral ( s1 ) radiculopathy . 
 bilateral movements with the unilateral lesion , and fluctuation with postural changes and distant muscle contraction suggest that the underlying pathomechanism was a central reorganization in the spinal level .