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Ipsilateral limb extension with downgoing toes versus the normal<br />
plantar response<br />
Proximal stimulation of the lower limb in patients with exaggerated<br />
exteroceptive reflexes can result in contraction of quadriceps and triceps<br />
surae, together with plantar flexion of the toes (physiological toe extension).<br />
This extensor synergy is the counterpart of the flexor movements<br />
that are evoked on distal excitation. It was first described by Remak ( 1893 ),<br />
in a 4-year-old boy with myelitis; he called it 'Femoral-reflex', after the<br />
receptive zone. Marie and Foix (1912, 1913) indicated, as in the flexion<br />
reflex, the analogy between these extensor movements in man (' reflexe<br />
des allongeurs') and similar phenomena observed in spinal animals<br />
(Sherrington, 1910). Walshe (1914) and Riddoch (1917) postulated that<br />
extension reflexes depended on supraspinal influences and were not met<br />
with in spinal man, bur eventually this view had to be rectified (Kuhn,<br />
1950; Guttmann, 1952).<br />
Babinski (1904, a, b) suggested that the downward movements of the<br />
toes in this pathological synergy were identical with the plantar response<br />
in normal subjects - an idea recently exhumed by Bathien and Bourdarias<br />
(1972). However, it was argued by van Gehuchten (1900 b), and in more<br />
detail by Marie and Foix (1912, 1913) as well as by Walshe (1914), that the<br />
normal plantar response is a skin reflex in a strict sense: a unisegmental<br />
reflex with a limited receptive field and a correspondingly limited effect,<br />
quite comparable to the abdominal and cremasteric reflexes. Whereas<br />
plantar flexion of the toes as part of an extension synergy can be evoked<br />
only by stimuli outside the sole of the foot, the reverse is the case for the<br />
normal plantar reflex. Moreover, the response in healthy subjects is never<br />
accompanied by activity in other physiological extensor muscles. It is, on<br />
the contrary, often superimposed upon the usually moderate flexion reflex<br />
that follows plantar stimulation in normal circumstances. This coexistence<br />
in itself is no proof of synergistic linkage, as Landau and Clare<br />
(1959) imply- that would take us back to Babinski's original 'transformation'.<br />
Additional evidence for the 'simple' nature of the downward toe<br />
response is found in patients with spinal shock (Chapter V, p. 115).<br />
Crossed toe responses<br />
1. Crossed plantar flexion, usually in a foot showing a Babinski response<br />
when stimulated directly. This phenomenon was noticed, without further<br />
explanation, by Babinski (1898), Collier (1899) and Klippel eta!. (1908). It<br />
was stressed by Steinberg (1908), Maas (1911) and Pastine (1913 a) that<br />
crossed plantar flexion of the toes could be observed in paretic limbs
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