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Babinski Reflex (Extensor Plantar Reflex): Physical Exam

    Definition
    • Dorsiflexion of the big toe and hyperextension of other toes in response to a noxious stimulus applied to the lower extremity
    Indications
    • Neurological assessment when evaluating for the presence of an upper motor neuron or CNS pathology
    Technique
    1. Grasp the patients ankle with one hand
    2. Stroke the sole of the foot, beginning at the heel and proceeding up the lateral aspect and then across the metatarsal heads toward the big toe (do not touch the toes)
    Results
    • Positive (Abnormal Finding):
      • Dorsiflexion of the big toe and hyperextension of other toes
    • Negative (Normal in Adults):
      • Brisk plantar flexion; often associated with dorsiflexion of the foot at the ankle
    • False-Positive: rapid withdrawl flexion at the hip and knee, dorsiflexion of the foot, and sometimes dorsiflexion of all the toes (no toe fanning)
      • Can be produced by "tickling" the patients foot - avoid this by stroking the lateral/outer aspect of the foot and not the ticklish part of the sole
      • To help get an accurate assessment, advise the patient that the test is unpleasant and is likely to tickle and that they should try very hard not to withdrawl their foot  
    Pearls
    • This reflex is normal in children up to 2 years of age (can disappear as early as 12 months)
    • As the nervous system matures, the toes often curl down instead of up in response to stimuli
    • A Babinski sign that persists past 2 years of age denotes dysfunction of the brain or nervous system including:
      • Amyotrophic lateral sclerosis (Lou Gehrig disease)
      • Brain tumor or injury
      • Meningitis
      • Multiple sclerosis Spinal cord injury, defect, or tumor
      • Stroke
    Editors & Reviewers

    Editors:

    • Anthony J. Busti, MD, PharmD, FNLA, FAHA

    Last Reviewed: September 2016

    References
    1. Griggs RC, Jozefowicz RF, Aminoff MJ. Approach to the patient with neurologic disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 403.
    2. Hockenberry MJ, Wilson D. Wong's Essentials of Pediatric Nursing. 8th ed. St. Louis, MO: Mosby Elsevier. 2009;152,211.
    3. Lehman RK, Schor NF. Neurologic evaluation. In: Kliegman RM et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 584.
    4. Orient, JM. Sapira's Art and Science of Bedside Diagnosis. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2010;576.
    5. van Gijn J. The Babinski reflex. Postgrad Med J. 1995;71(841):645-8.