Sign, toe

An important neurologic test based upon what the toes do when the sole of the foot is stimulated. If the big toe goes up, that may mean trouble. The toe sign, also called the Babinski reflex, is obtained by stimulating the external portion (the outside) of the sole. The examiner begins the stimulation back at the heel and goes forward to the base of the toes. There are diverse ways to elicit the Babinski response. A useful way that requires no special equipment is with firm pressure from the examiner's thumb. Just stroke the sole firmly with the thumb from back to front along the outside edge. Too vigorous stimulation may cause withdrawal of the foot or toe, which can be mistaken as a Babinski response. The normal mature toe sign is characterized by extension of the great toe and also by fanning of the other toes. Most newborn babies have a Babinski response, a reflection of their nervous system immaturity. Upon stimulation of the sole, they extend the great toe . Many young infants do this, too, and it is perfectly normal. However, in time during infancy the Babinski response vanishes and, under normal circumstances, should never return. A Babinski response in an older child or adult is abnormal. It is a sign of a problem in the central nervous system (CNS), most likely in a part of the CNS called the pyramidal tract. Asymmetry of the toe sign — when it is present on one side but not the other — is abnormal. It is a sign not merely of trouble but helps to lateralize that trouble (tell which side of the CNS is involved). The toe sign is known by a number of other names: the plantar response (because the sole is the plantar surface of the foot), the big toe sign or phenomenon, the Babinski phenomenon or sign. (It is incorrect to say that the Babinski sign is positive or negative; it is present or absent). Babinski, despite the Slavic sound of the name, was French: Joseph Francois Felix Babinski (1857-1932). His name will never be forgotten in medicine, thanks to the toe sign he described.