THE PLANTAR REFLEX - RePub

and Clare, 1959; confirmed by the findings described in Chapter III).
Nonetheless, observation of activity in other leg flexors has rarely been
applied as a tool in the interpretation of equivocal toe responses. At least
this was true for all but one of a sample of fifty neurologists, who did not
object to rating plantar reflexes from films which showed only the foot
(see Chapter II). In published work there is also a paucity of allusions to the
practical use of the flexion reflex in this respect. Some early writers even
declare that any upward movement of the hallux should be discounted if it
is not an isolated phenomenon (Hamburger, 1901; Crocq, 1901; Levi,
1902; de Wilde, 1911). They heralded the present-day preoccupation with
toe movements alone.
Only at the time of Babinski's discovery a few neurologists were able to
make practical use of the connection between the toe responses and the
more proximal effects which had until then constituted the plantar reflex.
Collier (1899) stated: · ... it is very important that all the muscles of the
lower limb should be observed at the moment of stimulation'. And Koenig
(1899, 1900) even employed a second observer, who ' ... focused his
attention on the events which occurred higher up .. .'. Finally, Babinski
himself has always stressed the synergistic nature of his sign, although we
have seen in Chapter I that he insisted on including the normal response in
the flexion reflex. Babinski also perceived an important application: reflex
movements of the great toe often coincide with contraction of the tensor
fasciae latae, whereas this is never seen during voluntary retraction of the
toes (Babinski, 1906 a, 1915 b, 1922). The same counsel was given by
Specht (1902).
One of the aims of the study described in this chapter is to find out
whether the present neglect of the flexion reflex as a whole in the
interpretation of equivocal plantar responses is justified or not.
Procedures to 'enhance' the Babinski sign
Apart from stimulation itself, some indirect influences on the plantar
reflex have been described in previous studies, often with the implication
that these could be of use in dubious cases:
1. Temperature of the foot: little response in cold feet, reflex return on
warming (Collier, 1899; Kalischer, 1899; Babinski and Froment, 1916;
Noica and Radovici, 1919).
2. Ischaemia of the leg: immediately after restoration of normal blood
flow, there is a transient enhancement of withdrawal reflexes (Babinski,
1911 b; Marinesco and Noica, 1913; Gilliatt, 1952).
3. Tonic neck reflexes: rotation of the subjects' head away from the
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