Did you know there are several foot reflexes?

Most people are familiar with Babinski as part of a standard neurological assessment for upper motor neuron lesion.

Did you know that there is considerable debate as to what exactly the Babinski reflex is and what it can tell?

For example, there is a “soft sign” version of Babinski which uses non sharp touch for the assessment.

My thoughts on this post are related to the variability seen in gait and foot strike patterns. I believe that remnants of neurological pattern could be involved in this variability. In a mature nervous system, primitive reflexes do not “disappear”. They are inhibited by the higher centres, especially the frontal lobe (e.g., “frontal release signs”). There is a considerable amount of variability in the inhibition of primitive reflexes, which leaves the possibility for the foot primitive reflexes to be involved in the variability seen in gait and foot strike pattern.

  • Heel grasp: extensor dominant pattern with the tactile stimulus on the postero-inferior calcaneal region on the sole of the foot.
  • Babinski: flexor dominant pattern with the tactile stimulus on the lateral border of the foot.
  • Plantar grasp: extensor dominant pattern with the tactile stimulus on the metatarsal heads on the sole of the foot
  • Foot tendon guard: this reflex is often considered the “fraternal twin of Babinski”. This produces an extensor dominant pattern with the tactile stimulus on the medial border of the foot.

(Note: there are other foot reflexes, but left out here for simplicity).

The tactile stimulus of these reflexes is involved in the development of locomotor function (e.g., rolling, creeping, crawling, gait) and disturbances in development (e.g., early walking or skipping crawling) injuries, or neuroinflammation could allow more of the reflex pattern to present, creating changes in gait.

Are the primitive reflexes modifiable? This depends on the causation, but many times the time they are in an orthopaedic population.