With a key or the wooden end of an applicator stick, stroke the lateral aspect of the sole from the heel to the ball of the foot, curving medially across the ball (Fig. 1). Use the lightest stimulus needed to provoke a response, but increase firmness if necessary. Closely observe movement of the big toe, normally plantar flexion.

FIGURE 1. Test the plantar response.

Some patients withdraw from this stimulus by flexing the hip and the knee. Hold the ankle, if necessary, to complete your observation. At times it is difficult to distinguish withdrawal from a Babinski response.

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