PLANTAR REFLEX

 Plantar reflex is a nociceptive segmental spinal reflex.

 Its segmental innervation is S1 segment of the spinal cord.

 The clinical significance lies in the fact that the abnormal response
reliably indicates metabolic or structural abnormality in the
corticospinal system upstream from the segmental reflex.
 It was first described by Babinski.
 TECHNIQUE
 Position the patient in supine with hip and knee extended.
 The equipment used should be a dull,blunt instrument that
doesn’t cause pain or injury like the dull point of a reflux
hammer or the edge of a key etc.
 Fix the ankle joint by holding it and stroke (gentle but firm
pressure) the outer aspect of sole with a blunt point.
 The stroke is directed forward and then curves inward along the
metatarsophalangeal joints from the little to the big toe and stopped short of
the base of great toe (root value SI).
INTERPRETATION
 This normal plantar response is called Flexor plantar response.
 Normal response is great toe will flex at the metatarsophalangeal joint accompanied by flexion
of other toes.
PATHOGENESIS OF NORMAL
PLANTAR RESPONSE
 • Stimulation of the lateral plantar aspect of the foot (S1 dermatome) normally leads to plantar
flexion of the toes (due to stimulation of the S1 myotome).
 The response results from nociceptive fibers in the S1 dermatome detecting the stimulation.
 Nociceptive input travels up the tibial and sciatic nerve to the S1 region of the spine and
synapse with anterior horn cells. The motor response which leads to the plantar flexion is
mediated through the S1 root and tibial nerve.
ABNORMAL RESPONSES
 ABSENT PLANTAR
No response is seen.
Plantar response/reflex may be absent when
 there is loss of sensation of the sole (L5-S1)
 thick sole
 paralysis of the extensor hallucis
 lesions of reflex arc.
EXTENSOR PLANTAR REFLEX / BABINSKI’S SIGN
Extension (dorsiflexion) of the great toe with or without fanning of others toes (abduction) is
known a Babinski's sign (mediated by L5).
It usually indicates dysfunction of corticospinal tract
Components of Babinski’s sign
 DORSIFLEXION OF GREAT TOE AT MTP
 FANNING OUT AND EXTENSION OF OTHER TOES
 DORSIFLEXION OF ANKLE
 FLEXION OF HIP AND KNEE
 CONTRACTION OF TENOR FASCIA LATA
Its causes are:
 Physiological
 It may be normally extensor in infants below 6 months
 during deep sleep and under general anesthesia
 Pathological:
 Lesion of corticospinal (pyramidal) tract above S1 segment
deep coma
 transiently after seizure
 Alcohol intoxication
 hypoglycemia
 metabolic encephalopathy.
 PATHOGENESIS OF BABINSKI SIGN
 The descending fibers of the CST normally keep the ascending sensory stimulation
from spreading to other nerve roots.
 When there is damage to the CST, nociceptive input spreads beyond S1 anterior
horn cells. This leads to the L5/L4 anterior horn cells firing, which results in the
contraction of toe extensors (extensor hallucis longus, extensor digitorum longus)
via the deep peroneal nerve
 Babinski sign occurs when stimulation of lateral plantar aspect of the foot leads to
extension (dorsiflexion or upward movement) of the big toe . Also, there may be fanning
of the other toes.
 This suggests that there is been spread of the sensory input beyond the S1 myotome to L4
and L5. An intact CST would prevents such spread indicating dysfunction of CST
 a) MINIMAL BABINSKI SIGN : Contraction of hamstring muscles and tensor
faciae late.

 b) TRUE BABINSKI SIGN: Includes all the components of the fully

developed extensor plantar reflex.

 c) PSEUDO BABINSKI SIGN : One may encounter this type of response in

sensitive individuals, plantar hyperaesthesia, and choreoathetosis due to
hyperkinesis.
Babinski can be clinically distinguished from the false Babinski by the
contraction of hamstring muscles in the former, and failure to inhibit the
extensor response by pressure over the base of the great toe.
 d) EXAGGERATED BABINSKI SIGN: It can either be in the form of 'flexor
spasm' or 'extensor spasm', depending upon the muscles i.e. whether flexors or
extensors, have excess of tone. Flexor spasms occur in spinal cord disease,
bilateral upper motor neuron lesion at a supraspinal level, multiple sclerosis
and subacute combined degeneration of the cord, while 'extensor spasm' occurs
in patients with corticospinal tract lesion when the posterior column function is
normal
 e) INVERSION OF PLANTAR REFLEX: If the short flexors of the toe are
paralysed or flexor tendons are severed accidentally, an extensor response may
be obtained.
 f) TONIC BABINSKI REFLEX: Characterised by slow prolonged contraction
of extensors of toe, seen in frontal lobe lesions and extrapyramidal
involvement.
 WITHDRAWAL RESPONSE
the patient quickly pulls the foot back away from the stimulus
• In anxious individuals or
• in patients with peripheral sensory neuropathy or
• when an unduly sharp stimulus is given
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