Background: Restless legs syndrome (RLS) is a common condition characterised by unpleasant sensations deep inside the legs, which usually occurs at rest and especially at night. These sensations are accompanied by an urge to move the limb, and movements result in a temporary relief of the symptoms. The pathophysiology of RLS is not completely known, especially the role of afferent feedback. An individual with a below the knee amputation who developed restless legs in his real and phantom limbs is reported. Methods and results: A 54-year-old man with a left leg amputation 22 years ago developed RLS, primarily at night, that met the International RLS Study Group's criteria for RLS. This RLS, however, involved both his real and phantom lower limbs. Movement and phantom movements, as well as treatment with dopamine agonists, relieved this symptom in both the real and amputated limbs. However, creating an image of the limb moving without "moving" the limb did not improve the uncomfortable sensations in either limb. Conclusions: That restless legs can occur simultaneously in a phantom as well as a real limb and that the perception of movement in a phantom limb as well as dopaminergic treatment improved the symptoms provides further support for the important role of central nervous system dysfunction in the development of this disorder.