Painful legs and moving toes associated with tarsal tunnel syndrome and accessory soleus muscle

Abstract

Painful legs, moving toes is a rare syndrome characterized by leg pain and uncontrolled toe movements. We present a 35-year-old man with a 1-year history of unilateral knee, calf, and medial ankle pain with spontaneous movements of second through fifth toes. Electrodiagnostic studies showed an absent lateral plantar nerve response consistent with a tarsal tunnel entrapment neuropathy. Cine magnetic resonance imaging revealed a large accessory soleus muscle compressing the flexor hallucis longus in the tarsal tunnel of the affected extremity. Lidocaine block of the tibial nerve at the popliteal fossa did not stop these movements, but blockade of the medial and lateral plantar nerves distal to the medial malleolus stopped them temporarily. Treatment with foot orthotics and cessation of running activity decreased the symptoms. We conclude that painful leg and moving toes in this patient resulted from a compression neuropathy at the tarsal tunnel possibly caused by a large adjacent accessory soleus muscle.