Reflex question

[biowham]

I know what it means if you have Babinski's sign. What does it mean if your toes don't do anything, if you have an "indifferent" plantar response?

Thanks,
E

[Weesy68]

Late in commenting, but the silent Babinski should be silent in both feet, otherwise a reaction in one foot and silent in the other implies an abnormality in the silent foot.  So no reaction in this case when it applies to just one foot while the other does a normal downward motion would imply a problem in the silent foot because it isn't reacting the same as the downward foot if that makes sense.

[Quixotic1]

I reread all of your posts.  I think the "indifferent plantar response" refers to the Babinski sign.  Some doctors like to describe all signs in the exam to their anatomical reponse and not to their "names."  So, many neuros call the Babinski the "plantar response."  (because it is performed on the plantar surface of the foot)  "Indifferent" would mean no movement of the great toe, and would be normal or of no significance.

Q

[Quixotic1]

Hi, E.  The sole of the foot is called the plantar surface.    When you tap the heel tendon the foot moves downward in a motion called "plantar flexion."  That is whay it is called the plantar reflex.  

The top of the foot is the dorsal surface.  When you raise you toes and foot upward it is called "dorsiflexion."

I was taught that in trying to elicit the Babinski, no motion of the great toe is considered a negative Babinski, and is normal.

Hope this helps.  Q

[Momzilla]

I'm no expert.  All I wrote is all I know.  I'm sorry I misunderstood!  A lot of things are just over my head.

Good luck in your quest!

Zilla*

[biowham]

Evidently, I'm phrasing my question poorly. I'm going to rephrase it another time. Thanks for taking the time to respond.

E

[melinda68]

Wow, what an ******* you are

[TiredPT]

Achilles tendon is the bottom half of the gastrocnemius muscle (tendons are merely the ends of the muscle that narrow and connect it to the bone).  The gastrocneumius is a knee bender and a plantar flexor (makes foot point down like a ballerina) so when the reflex is checked behind the ankle, if it is intact, it will result in plantar flexion of the foot.  A hyperactive reflex (too brisk) is indicative of an upper motor neuron lesion -- something wrong in the brain or upper levels of the spinal cord.  A hypoactive reflex (minimal response) is indicative of lower motor neuron lesion -- something wrong in the lower half of the spinal cord or a nerve pinching somewhere else (i.e., like sciatica from the pelvis being out of alignment or one of the deep muscles in the pelvis being VERY unhappy and in spasm.  If things are asymmetrical (different from one side to the other), it is often considered more important than if they are symmetrically absent or symmetrically brisk . . . . depends on all the other stuff and the neuro.

Hope this helps.

[Rena705]

Good afternoon my dear...don't know that I can help much but I do know that the plantar fascia  connects the area of the foot near the toes with the heel and being that the Achilles Tendon is in the heel area I would imagine that is why they call it the plantar response.  I am just musing here but figure it might make sense.

Rena

[biowham]

I'm not concerned. My point to Zilla was that Babinski's is the name of the abnormal reflex, so I'm not talking about that, which I don't have. And yes, it's called the indifferent plantar response when there is not flexion or extension, or at least it is by some people. What I find in the literature is that some people consider it relevant while others do not, and I was looking for personal experience with that here. I was not seeking a definition or other explanation of the reflex itself.

Why would the reflex involving the Achilles be called "plantar anything"?

FWIW, I have the abnormalities you list, as well.

E

[TiredPT]

"Indifferent plantar response?"  Are you talking about the reflex when they bonk you on the backs of the ankles -- achilles tendon??  Or are you talking about then they stroke the bottom of the foot and nothing happens??

Either way, I agree with Z.  Reflexes can be very hard to get at times, particularly if the person is tense/unable to relax.  I rarely, if every, have trouble checking the reflexes in general, but the triceps and plantar flexion tend to be more difficult to get overall.  If both sides are equal, in the absense of other neurological abnormalities such as sensation loss (temperature, pin *****, light touch, vibration, proprioception, etc.), and muscle weakness (i.e., to manual muscle testing or functional testing like unable to heel walk or toe walk), I wouldn't be too concerned about this in particular.  But just my 2 cents worth . . . . .

Teresa

[Momzilla]

As far as I know it's a "tomato/tomahto" scenario.  Same thing, different names.  From what I've read, an indifferent response is considered normal.

I'm sure if someone has heard differently, I will be corrected in the manner I deserve!

Take care!

Zilla*

[biowham]

Hi, Mom--

I know what the Babinski sign means. I was asking about the plantar reflex (in the absence of Babinski's sign). I've read that an indifferent plantar response can be meaningful, so I was interested to see if anyone had any empirical info on that.

Thanks!
E

[Momzilla]

Hi, Emily~

April's right about the Babinski.  If the toes are "silent," it is considered normal.  With Babinski, it's either you have a response, or you don't.  So, with the 'silent' response, or having your toes not move at all, or if they were to curl under, which would be the more anticipated reaction, it is said the patient has no Babinski's sign.

If the great toe goes up, or if the combination occurs where the great toe goes up and the little toes fan out, the patient is said to have the Babinski sign or response.  

HOWEVER, it can be tricky for some doctors to perform.  Right after I had my worst episode of paresis, where I could not lift my legs, a neuro tried the Babinski, and got no response.  I don't know if it should have been there then, I am just saying, I was pretty bad and weak in those days.  And he was a nimrod.  

And my favorite neuro so far did elicit the Babinski response in my right side at my first visit with him, a few times to show his student, and the very same week, my internist could not reproduce it.  I was 'silent.'  So.....I hope that clears things up for you!

I didn't mean to confuse you or give you any false hope.  Not that you want the Babinski sign.  I'm sure you know what it means.  I'd gladly give it back.  Sell it on E-Bay to the highest bidder.  Or the lowest, for that matter.

Good luck interpreting what I've said!

Zilla*

[biowham]

Hi, Mae-

Thanks for responding. My toes don't move at all, not the big ones, not the little ones. No curling, no nothing.

E

[mae1]

Hi E,  I've been tol if the toe do's nothing, dosnt move either way, it a normal response.
only if the big toe stands straight up and the other toes fan out is it a Babinski sign.
my right big toe just sits there, dosnt do anything but my left toes all curl under so my neuro said their both normal. hope that helps you.
april