THE PLANTAR REFLEX - RePub

One such category is formed by alert patients with long-standing
hemiplegia who have gradually developed a dystonic posture on the
paralysed side, whilst the Babinski sign has disappeared or can be evoked
only from other areas than the sole of the foot. Involuntary clenching of
the fingers is then often also present, together with activity in other flexor
muscles of the arm. This clinical picture is described or implied by
Barraquer (1921), Barraquer-Ferre (1930), Goldstein (1931), Landau and
Clare (1966), and Dooling and Adams (1975 ). The report by Lomtadse
( 1932) has a special flavour, not only because tonic plantar flexion of the
toes is produced by sliding the thumb along the tibia, but also because of
the 'balneological significance' attached to it: hot mud baths might
precipitate a stroke in these patients.
A second type of cerebral disease in which tonic plantar flexion of the
toes has been found is in diffuse dysfunction of the frontal lobes, also
manifested by palmar grasping, sucking responses, and severe intellectual
impairment. In these cases the downward response of the toes is often
produced only by pressure or light touch on the sole, while stronger stimuli
give a Babinski sign. Extensive damage of the frontal lobes was possibly
present in the patient described by Schuster and Pineas (1926 - 'forced
grasping' of rhe foot). This can be stated more confidently for three of the four
cases of Brain and Curran ( 1932- 'grasp reflex of the foot') and for the seven
patients reported by Goldstein in 1938 ('tonic foot response')- all these ten
patients suffered from a cerebral space-occupying lesion.
A purely proprioceptive type of tonic activation of the toe 'flexors' was
distinguished by Alajouanine eta!. (1968); in such cases it is produced only
by muscle stretch during walking or even standing. Distinction from the
exteroceptive form is not always possible: Cohen and Iannone ( 1967)
report a patient in whom all sorts of stimuli resulted in plantar flexion
(only of the small roes and the foot, while the hallux went up). And
Manfredi eta!. (1975) give three case histories where only the combined
effect of exteroceptive and proprioceptive stimulation during walking
produced the 'tonic ambulatory foot response', whereas neither noxious
stimulation nor passive stretch alone could bring it about.
A paradoxical tonic downward response of the toes may be found not
only in patients with cerebral lesions, but also in patients with a recent
transverse lesion of the spinal cord. This latter phenomenon will be
discussed in Chapter V.
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