As per the results of a case series published in 'Journal of Neurology', painful legs and moving toes (PLMT) syndrome is fundamentally a chronic pain disorder, possibly relating to the central sensitization, encompassing the region of a part of the pain matrix. 

PLMT syndrome is a clinical entity marked by persistent pain in the feet or legs and the involuntary movements of one or more toes. The exact pathomechanisms of PLMT are still unknown. Kenya Nishioka and researchers assessed 10 patients clinically associated with PLMT syndrome. All the patients first presented persistent pain preceding the onset of motor symptoms. The neurological investigation, neuro-imaging methods comprising brain magnetic resonance imaging (MRI) and electrophysiological techniques were used for the examination of each patient. The brain single-photon emission computed tomography (SPECT) images of 8 patients revealed hypoperfusion of frontal lobes and cerebellum. Conjunction analysis of brain SPECT imaging of all eight patients, using the 3D-SSP program, compared to 34 controls pointed to significant hypoperfusion in the prefrontal cortical, cerebellar surfaces and occipital cortical and thalamus, and hyperperfusion in the surface of the anterior cingulate gyrus and parietal cortices comprising primary and secondary somatosensory cortices, bilaterally. Specific abnormalities were not indicated by other electrophysiological examinations to describe the patients' symptoms. After treatment foot-related motor symptoms of four out of nine patients got resolved but the sensory symptoms were not resolved on treatment with Clonazepam. All in all, their pain was an intractable and persistent symptom during their clinical course. 

The investigators concluded that further studies with large patient populations are needed to verify the results of this analysis.