THE PLANTAR REFLEX - RePub

eference) it is not surprising that the distinction from spontaneous toe
wriggling was problematical. Arbitrary restrictions such as counting only
the very first movement (Hogan and Milligan, 1971) do not solve the
problem (Landau, 1971). The neglect of the synergistic background of
upward reflex movements of the toes is the second major factor which has
contributed to the chaos about the infantile plantar reflex.
Although Babinski (1898) and some of his contemporaries (Collier,
1899; van Woerkom, 1910, 1911) clearly described dorsiflexion of the
hallux in children after a vigorous stimulus as part of what we now call the
flexion reflex, preoccupation with toe movements alone has been even
more persistent in the pediatric literature than in adult neurology. For
example, in a fairly recent manual for the neurological examination of the
new-born infant (Prechtl and Beintema, 1964) the Babinski reflex appears
under one heading and the withdrawal reflex under another. Since the
plantar reflex became established in the pediatric examination, the identity
of the upgoing hallux response with the withdrawal reflex has been
stressed only by McGraw (1941), Brain and Wilkinson (1959), Willemse
(1961) and Schoch (1967). Willemse peremptorily denies that this upward
toe response of new-borns is similar to the Babinski sign in adults. He
defines the latter as slow dorsiflexion of the hallux alone, with fanning of
the other toes. The distinction is shared by Chaney and McGraw (1932)
and Touwen (1975). But such a conclusion about adults can hardly follow
from a study of infants, however detailed, and is refuted by a wealth of
evidence which has been reviewed earlier in this chapter.
The normal plantar response and walking
It is rather obvious to suppose a connection between the change of the
plantar response to the normal adult type and the beginning of walking,
because these two events occur more or less at the same stage of normal
development. Leaving all speculations aside (these are relegated to the
next section), only observations in individual children will be taken into
account here.
Collier (1899) and Barnes (1904) intimate that reversal of the plantar
reflex is delayed in children who walk late. Some even draw a parallel
between the direction of the reflex with the position of the great toe
during locomotion (Munch-Petersen, 1902), and examples are cited of a
persistent upward response in children wearing sandals (Schlesinger,
1927; Stolte, 1933 ).
On the other hand, Feldman (1922) and de Bruin (1928) failed to
demonstrate a fixed coincidence of a changing toe response and the onset
of walking in their series of normal children. Tournay (1922) records the
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