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The Babinski sign
  1. Matthew C Kiernan1,2
  1. 1Bushell Professor of Neurology, Sydney Medical School, Sydney, New South Wales, Australia
  2. 2Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Matthew C Kiernan, Brain and Mind Centre, University of Sydney, Sydney, NSW 2040, Australia; matthew.kiernan{at}sydney.edu.au

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You cannot have completed your training as a neurologist unless you can make the plantar response go up or down. Or so the apocryphal story goes.

Of all the neurologists who have found fame, at least such that they continue to be commemorated by acolytes worldwide and on a daily basis, Joseph Babinski (1857–1932) must be considered to have the greatest, at times most dramatic influence, and indeed sustained impact on clinical neurology. Yet are we really serious about questioning the veracity of this eponymous response and any clinical implications?

Run a car key (figure 1; or as some have suggested, a most expensive motor car key, ie, ‘moat–aah-cah keeee’, ideally pronounced in the lowest possible timbre) along the lateral border of the sole. A normal response invokes flexion of the great toe. Conversely, an upgoing toe is generally attributed to a lesion involving the pyramidal tract.

Figure 1

Tools of the trade. Random sample obtained at a neurologist's retirement event.

How many grand round presentations have you witnessed, starting with demonstration of clonus, increased tone, brisk knee reflexes, and then…the toe goes down. Dear chap, could we …

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    Phil Smith Geraint N Fuller