Many patients with restless legs syndrome (Willis-Ekbom disease) complain of 
burning sensations in their feet associated with the desire to move, such that 
they seek cooler environments. This pilot study aimed to characterise the 
microvascular skin changes in 12 patients with restless legs syndrome compared 
with 12 age- and sex-matched controls. Patients with moderate or severe restless 
legs syndrome and controls underwent detailed thermovascular assessment in a 
controlled temperature room at three different stages (normothermic phase 23 °C, 
hot phase 30 °C, cold phase 18 °C). Microvascular activity was recorded during 
all phases by bilateral great toe laser-Doppler flowmetry and also by whole-body 
thermography. Patient and control measurements were compared. The study protocol 
was well tolerated. Parameters extracted from the laser-Doppler flowmetry 
measurements were used to model a logistic function using binary logistic 
regression. This demonstrated a statistically significant difference between 
patients with restless legs syndrome and healthy controls (P < 0.001). Visual 
inspection of the body thermography image sequences showed increased lower limb 
movement in patients with restless legs syndrome patients compared with 
controls. Thermography analysis also showed significant differences between foot 
temperatures in patients with restless legs syndrome compared with controls 
during the hot phase (P = 0.011). Notably, patients with restless legs syndrome 
had more uniform foot temperatures, whereas controls had a wider variability in 
surface temperature across the feet. This novel study demonstrates impaired 
microvascular circulation in patients with restless legs syndrome in comparison 
to matched controls and a potential mechanism for the sensation of burning feet. 
The protocol also provides an experimental paradigm to test therapeutic 
interventions for the future.