The psychogenic toe signs.

A 13-year-old boy presented with sudden-onset give-away weakness, nonanatomic sensory loss, and posturing of the right foot followed by episodic left leg tremor, relatively unchanged for 14 months prior to this evaluation. The right first toe was fixed in extension; the others in flexion. Although there was resistance to passive plantar flexion, such movement occurred spontaneously upon forced extension of the second–fifth toes (figure; video on the Neurology Web site at www.neurology.org), unlike the behavior seen in organic striatal toe.1 Fixed posturing and resistance to manipulation are features of psychogenic dystonia.2 Foot flexion and inversion, without toe extension, appears to be the more common phenotype of psychogenic foot dystonia.