Babinski Reflex (Extensor Plantar Reflex): Physical Exam
- Dorsiflexion of the big toe and hyperextension of other toes in response to a noxious stimulus applied to the lower extremity
- Neurological assessment when evaluating for the presence of an upper motor neuron or CNS pathology
- Grasp the patients ankle with one hand
- 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)
- Positive (Abnormal Finding):
- Dorsiflexion of the big toe and hyperextension of
- 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
- 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
Amyotrophic lateral sclerosis (Lou Gehrig
- Brain tumor or injury
- Multiple sclerosis Spinal cord injury, defect, or tumor
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;
- Hockenberry MJ, Wilson D. Wong's Essentials of Pediatric Nursing. 8th ed. St. Louis, MO: Mosby Elsevier. 2009;152,211.
- 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.
JM. Sapira's Art and Science of Bedside Diagnosis. 4th ed. Philadelphia, PA:
Lippincott Williams & Wilkins. 2010;576.
- van Gijn J. The Babinski reflex. Postgrad Med J. 1995;71(841):645-8.