Functional Neurological Disorder: A Case of Twisted Toes and Dystonia

Functional neurological disorders (FNDs) continue to pose diagnostic challenges, often resembling organic neurological conditions and leading to extensive but unnecessary testing. FNDs commonly present with motor and sensory symptoms that fluctuate and improve with distraction, favoring differentiation from structural diseases. This case describes a 53-year-old female with bilateral lower extremity pain and toe contractures, initially concerning for an organic movement disorder or peripheral neuropathy. Examination revealed distractible dystonia, normal strength, and negative neuroimaging, supporting a diagnosis of FND. Despite prior similar presentations, diagnostic uncertainty and the presence of comorbid conditions such as diabetic peripheral neuropathy complicated the evaluation. Our report emphasizes the importance of recognizing positive clinical signs, reducing reliance on exclusion-based diagnosis, and addressing stigma to improve patient care and management.