What is the differential diagnosis for a 60-year-old female experiencing intermittent episodes of toe hyperextension (hyperextension of all toes on one foot), lasting a few seconds, occurring several times over the past few months, without any additional symptoms?

Differential Diagnosis for 60 year old female with random episodes of toe hyperextension

• Single most likely diagnosis + Peripheral neuropathy: This condition is characterized by damage to the peripheral nerves, which can cause muscle weakness, numbness, and twitching. The random episodes of toe hyperextension could be due to abnormal nerve impulses affecting the muscles of the foot.
• Other Likely diagnoses + Foot cramps: Foot cramps are a common condition that can cause sudden, severe pain and muscle spasms in the foot, including toe hyperextension. + Restless leg syndrome: Although typically associated with an urge to move the legs, restless leg syndrome can sometimes cause involuntary movements, including toe hyperextension. + Anxiety or stress-related movement disorders: In some cases, anxiety or stress can trigger movement disorders, including involuntary movements of the toes.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Stroke or transient ischemic attack (TIA): Although unlikely, a stroke or TIA can cause sudden, unexplained movements, including toe hyperextension. It is essential to rule out these conditions due to their potential severity. + Multiple sclerosis: This chronic autoimmune disease can cause a wide range of neurological symptoms, including muscle spasms and involuntary movements. + Neuromuscular junction disorders (e.g., myasthenia gravis): These conditions can cause muscle weakness and involuntary movements, including toe hyperextension.
• Rare diagnoses + Dystonia: A neurological disorder characterized by involuntary muscle contractions, which can cause abnormal postures, including toe hyperextension. + Hemifacial spasm or other focal dystonias: Although typically affecting the face, these conditions can sometimes cause involuntary movements in other parts of the body, including the toes. + Neurodegenerative diseases (e.g., Huntington's disease, Parkinson's disease): These conditions can cause a wide range of movement disorders, including involuntary movements of the toes, although they are relatively rare and typically associated with other symptoms.