Plantar reflex

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Plantar reflex
Babinski response/Babinski sign (pathological)
Lawrence 1960 20.4-en.svg
The reflex occurs upon stroking of the sole of the foot with a blunt object such as a pen. If the reflex occurs in adults as illustrated at bottom it may be due to nerve damage or disease.
ICD-9-CM 796.1
MedlinePlus 003294

The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms. In healthy adults, the plantar reflex causes a downward response of the hallux (flexion). An upward response (extension) of the hallux is known as the Babinski response or Babinski sign, named after the neurologist Joseph Babinski. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants. [1]

Contents

While first described in the medical literature by Babinski in 1896, [2] the reflex has been identified in art at least as early as Botticelli's Virgin and Child with an Angel , painted in the mid-15th century. [3]

Methods

Pathological Babinski's sign in adult BabinskiSign.jpg
Pathological Babinski's sign in adult

The lateral side of the sole of the foot is rubbed with a blunt instrument or device so as not to cause pain, discomfort, or injury to the skin; the instrument is run from the heel along a curve to the toes [4] (metatarsal pads). Many reflex hammers taper at the end of the handle to a point which was used for testing the plantar response in the past; due to the tightening of infection control regulation this is no longer recommended. Either a single use device or the thumb nail should be used.[ citation needed ]

There are three responses possible:

As the lesion responsible for the sign expands, so does the area from which the afferent Babinski response may be elicited. The Babinski response is also normal while asleep and after a long period of walking.

Interpretation

Babinski's sign in a healthy newborn Babinski-newborn.jpg
Babinski's sign in a healthy newborn

The Babinski sign can indicate upper motor neuron lesion constituting damage to the corticospinal tract. Occasionally, a pathological plantar reflex is the first and only indication of a serious disease process and a clearly abnormal plantar reflex often prompts detailed neurological investigations, including CT scanning of the brain or MRI of the spine, as well as lumbar puncture for the study of cerebrospinal fluid.

The phrase "negative Babinski sign" is sometimes used for the normal flexor plantar response. [6]

In infants

Infants will usually show an extensor response. In one study of 256 healthy infants, the response to testing was extensor in 73.8%, flexor in 8.9%, and equivocal in 17.3% [7] This extensor response occurs because the corticospinal pathways that run from the brain down the spinal cord are not fully myelinated at this age, so the reflex is not inhibited by the cerebral cortex. The extensor response usually disappears – giving way to the flexor response – by 12 months of age. [8] Its persistence beyond age 2–3 indicates a problem in the brain or spinal cord. [9] [10]

Pathways

Relationship to Hoffmann's reflex

The Hoffmann's reflex is sometimes described as the upper limb equivalent of the Babinski sign [12] because both indicate upper motor neuron dysfunction. Mechanistically, they differ significantly; the finger flexor reflex is a simple monosynaptic spinal reflex involving the flexor digitorum profundus that is normally fully inhibited by upper motor neurons. The pathway producing the plantar response is more complicated, and is not monosynaptic.

Babinski-like responses

The plantar reflex can be elicited in a number of ways, which were described in the late 19th and early 20th century. These have their own eponyms. [13] [14] [15]

Abnormal reflexes seen as flexion of toes

Related Research Articles

<span class="mw-page-title-main">Foot</span> Anatomical structure found in vertebrates

The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws and/or nails.

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The human leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.

<span class="mw-page-title-main">Toe</span> Digit of a foot

Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of their toes.

<span class="mw-page-title-main">Extensor hallucis longus muscle</span> Thin muscle, situated between the tibialis anterior and the extensor digitorum longus

The extensor hallucis longus muscle is a thin skeletal muscle, situated between the tibialis anterior and the extensor digitorum longus. It extends the big toe and dorsiflects the foot. It also assists with foot eversion and inversion.

The ankle jerk reflex, also known as the Achilles reflex, occurs when the Achilles tendon is tapped while the foot is dorsiflexed. It is a type of stretch reflex that tests the function of the gastrocnemius muscle and the nerve that supplies it. A positive result would be the jerking of the foot towards its plantar surface. Being a deep tendon reflex, it is monosynaptic. It is also a stretch reflex. These are monosynaptic spinal segmental reflexes. When they are intact, integrity of the following is confirmed: cutaneous innervation, motor supply, and cortical input to the corresponding spinal segment.

<span class="mw-page-title-main">Upper motor neuron lesion</span> Medical condition

An upper motor neuron lesion Is an injury or abnormality that occurs in the neural pathway above the anterior horn cell of the spinal cord or motor nuclei of the cranial nerves. Conversely, a lower motor neuron lesion affects nerve fibers traveling from the anterior horn of the spinal cord or the cranial motor nuclei to the relevant muscle(s).

<span class="mw-page-title-main">Tibial nerve</span> Branch of the sciatic nerve

The tibial nerve is a branch of the sciatic nerve. The tibial nerve passes through the popliteal fossa to pass below the arch of soleus.

<span class="mw-page-title-main">Flexor hallucis longus muscle</span> One of the three deep muscles in the lower leg

The flexor hallucis longus muscle (FHL) attaches to the plantar surface of phalanx of the great toe and is responsible for flexing that toe. The FHL is one of the three deep muscles of the posterior compartment of the leg, the others being the flexor digitorum longus and the tibialis posterior. The tibialis posterior is the most powerful of these deep muscles. All three muscles are innervated by the tibial nerve which comprises half of the sciatic nerve.

<span class="mw-page-title-main">Extensor digitorum brevis muscle</span> Muscle on the upper surface of the foot that helps extend digits 2 through 4

The extensor digitorum brevis muscle is a muscle on the upper surface of the foot that helps extend digits 2 through 4.

<span class="mw-page-title-main">Extensor hallucis brevis muscle</span> Muscle on the top of the foot that helps to extend the big toe

The extensor hallucis brevis is a muscle on the top of the foot that helps to extend the big toe.

<span class="mw-page-title-main">Deep fibular nerve</span> Type of nerve

The deep fibular nerve begins at the bifurcation of the common fibular nerve between the fibula and upper part of the fibularis longus, passes infero-medially, deep to the extensor digitorum longus, to the anterior surface of the interosseous membrane, and comes into relation with the anterior tibial artery above the middle of the leg; it then descends with the artery to the front of the ankle-joint, where it divides into a lateral and a medial terminal branch.

<span class="mw-page-title-main">Sole (foot)</span> Bottom part of foot

The sole is the bottom of the foot.

Primitive reflexes are reflex actions originating in the central nervous system that are exhibited by normal infants, but not neurologically intact adults, in response to particular stimuli. These reflexes are suppressed by the development of the frontal lobes as a child transitions normally into child development. These primitive reflexes are also called infantile, infant or newborn reflexes.

Hoffmann's reflex is a neurological examination finding elicited by a reflex test which can help verify the presence or absence of issues arising from the corticospinal tract. It is named after neurologist Johann Hoffmann. Usually considered a pathological reflex in a clinical setting, the Hoffmann's reflex has also been used as a measure of spinal reflex processing (adaptation) in response to exercise training.

<span class="mw-page-title-main">Chaddock reflex</span> Medical condition

The Chaddock reflex is a diagnostic reflex similar to the Babinski reflex. Chaddock's sign is present when stroking of the lateral malleolus causes extension of the great toe, indicating damage to the corticospinal tract.

The extensor digitorum reflex is tested as part of the neurological examination to assess the sensory and motor pathways within the C6 and C7 spinal nerves. It is also known as Braunecker-Effenberg reflex, or BER.

Cornell's sign is a clinical sign in which scratching along the inner side of the extensor hallucis longus tendon elicits an extensor plantar reflex. It is found in patients with pyramidal tract lesions, and is one of a number of Babinski-like responses.

<span class="mw-page-title-main">Babinski–Nageotte syndrome</span> Medical condition

Babinski–Nageotte syndrome is an alternating brainstem syndrome. It occurs when there is damage to the dorsolateral or posterior lateral medulla oblongata, likely syphilitic in origin. Hence it is also called the alternating medulla oblongata syndrome.

References

  1. ↑ synd/366 at Who Named It?
  2. ↑ Comptes rendus de la Société de Biologie, Vol. 48, 1896, p. 207, http://gallica.bnf.fr/ark:/12148/bpt6k6459605g/f225.image
  3. ↑ Massey, E. W.; Sanders, L. (1 January 1989). "Babinski's Sign in Medieval, Renaissance, and Baroque Art". Archives of Neurology. 46 (1): 85–88. doi:10.1001/archneur.1989.00520370087025. PMID   2642699.
  4. ↑ " plantar reflex " at Dorland's Medical Dictionary
  5. ↑ Acharya, Aninda B.; Jamil, Radia T.; Dewey, Jeffrey J. (2023), "Babinski Reflex", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30085551 , retrieved 2023-12-04, If there is no movement, then this is considered a neutral response and has no clinical significance." "Sometimes there is no response to stimulation. This is called a neutral response. This response does not rule out pathology.
  6. ↑ Larner, A. J. (2006). A Dictionary of Neurological Signs. Springer. pp. 50–. ISBN   978-0-387-26214-7.
  7. ↑ Gupta, A; Gupta, Piyush (July 2003). "Neonatal plantar response revisited". Journal of Paediatrics and Child Health. 39 (5): 349–351. doi:10.1046/j.1440-1754.2003.00172.x. PMID   12887664. S2CID   19382928.
  8. ↑ "Neonatal reflexes" . Retrieved 24 May 2017.
  9. ↑ "Medline plus: Babinski reflex" . Retrieved 24 May 2017.
  10. ↑ Neelon, Francis A; Harvey, Elisabeth (January 21, 1999). "The Babinski Sign". N Engl J Med. 340 (3): 196. doi:10.1056/NEJM199901213400305. PMID   9895399.
  11. ↑ Futagi, Y; Suzuki, Y (August 2010). "Neural mechanism and clinical significance of the plantar grasp reflex in infants". Pediatric Neurology. 43 (2): 81–6. doi:10.1016/j.pediatrneurol.2010.04.002. PMID   20610116.
  12. ↑ Harrop JS, Hanna A, Silva MT, Sharan A (2007). "Neurological manifestations of cervical spondylosis: an overview of signs, symptoms, and pathophysiology". Neurosurgery. 60 (1 Supp1 1): S14–20. doi:10.1227/01.NEU.0000215380.71097.EC. PMID   17204875. S2CID   22166615.
  13. ↑ Kumar, SP; Ramasubramanian, D (December 2000). "The Babinski sign--a reappraisal". Neurology India. 48 (4): 314–8. PMID   11146592.
  14. ↑ Walker, H. Kenneth; Hall, W. Dallas; Schlossberg, J. Willis Hurst; illustrations by Leon; Boyter, Charles H. (1990). "Chapter 73 The Plantar Reflex". In Walker, H. Kenneth (ed.). Clinical methods : the history, physical, and laboratory examinations (3rd ed.). Boston: Butterworths. ISBN   978-0-409-90077-4. Table 73.1 Variants of the Babinski Sign
  15. 1 2 Silva Rosas, Carlos (2013). Semiología y Fundamentos de la Neurología Clínica (First ed.). AMOLCA. pp. 66–67. ISBN   978-958-8760-73-5.
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