Restless legs syndrome (RLS) is a disorder characterized by an urge to move the lower limbs primarily at night. The urge is present at rest and is relieved by movement. However, in some cases the presentation is not straight forward and the diagnosis relies on a variety of supportive data rather than the formal diagnostic criteria alone. The present case is a representative example of this with atypical symptoms involving the urge to only move the toes rather than the legs. It highlights further unique features of RLS in that the patient’s symptoms were exacerbated by lithium and associated with nocturnal eating syndrome.