[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) › Babinski sign [Clinical exam](https://durgical.com/en/clinical-exam/) · [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) # Babinski sign - Sign When the sole is stroked, the big toe goes up instead of down; in adults it means damage to the brain or spinal cord motor pathway. Updated 2026-11-01 **See it in 3D:** [Spinal cord](https://durgical.com/en/anatomy/spinal-cord/) · [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/) ## Key points - Extensor big-toe response in an adult = corticospinal tract (upper motor neuron) lesion. - Normal in infants up to about 1 to 2 years, while myelination matures. - Stroke the lateral edge of the sole from the heel forward, curving towards the base of the big toe. - May be absent in the acute phase of severe spinal cord injury (spinal shock). - Chaddock (lateral foot below the malleolus) and Oppenheim (shin) look for the same response. ## What it is The normal adult plantar response is flexion of the toes when the outer edge of the sole is stimulated. The Babinski sign is the extensor response: the big toe extends slowly and the other toes may fan out. It is the classic sign of a corticospinal tract (upper motor neuron) lesion and is normal only in infants. ## The anatomy it tests - Tests the corticospinal tract from the precentral gyrus to the lumbosacral cord. - The plantar reflex arc uses the L5–S1 roots and the tibial nerve. - A normal corticospinal tract turns the primitive extensor response into a flexor one; when it is damaged, the primitive response returns. ## How to elicit it - Patient lying down with the leg straight and relaxed; warn the patient they will feel a firm stroke. - The examiner steadies the ankle with one hand. - With a blunt object (the hammer handle or a key), stroke the lateral edge of the sole from the heel forward. - On reaching the base of the toes, curve the stroke towards the base of the big toe. - Watch the first movement of the big toe: flexion (normal) or slow extension (Babinski). - Repeat on the other foot and compare. ## What a positive result means - Positive (big-toe extension, with or without fanning of the others): an upper motor neuron lesion anywhere from the cortex to the spinal cord. - Classic causes: stroke, multiple sclerosis, brain tumour or trauma, cervical myelopathy, spinal cord injury, meningitis or encephalitis, amyotrophic lateral sclerosis. - Bilateral in metabolic coma or after a seizure. - A flexor plantar response does not rule out an upper motor neuron lesion, especially in the acute phase. ## Usefulness and limits - Fairly specific for an upper motor neuron lesion but only moderately sensitive. - Voluntary withdrawal from tickling is mistaken for a Babinski: withdrawal is fast and moves the whole leg. - Stimulating the middle of the sole can trigger a toe grasp reflex. ## Test yourself Think of the answer, then tap the question to see it. ## Which pathway does the Babinski sign test? The corticospinal tract (upper motor neuron); damage to it brings back the primitive extensor response. ## At what age is an extensor plantar response normal? In infants, up to about 1 to 2 years of age. ## How is a Babinski sign told apart from withdrawal due to tickling? The Babinski is a slow extension of the big toe; withdrawal is quick, voluntary or ticklish, and moves the whole foot and leg. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/babinski-sign/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Spinal cord](https://durgical.com/en/anatomy/spinal-cord/) - [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/) ## Related - [Deep tendon reflexes and their grading](https://durgical.com/en/clinical-exam/deep-tendon-reflexes-and-their-grading/) - [Hoffmann sign and clonus](https://durgical.com/en/clinical-exam/hoffmann-sign-and-clonus/) - [Upper vs lower motor neuron syndrome](https://durgical.com/en/clinical-exam/upper-vs-lower-motor-neuron-syndrome/) - [Recognising a stroke: BE-FAST and the NIH Stroke Scale](https://durgical.com/en/clinical-exam/recognising-a-stroke-be-fast-and-the-nih-stroke-scale/) ## Related conditions - [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/) - [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/) - [Spinal cord injury](https://durgical.com/en/conditions/spinal-cord-injury/) - [Degenerative cervical myelopathy](https://durgical.com/en/conditions/degenerative-cervical-myelopathy/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [How To Assess Reflexes](https://www.msdmanuals.com/professional/neurologic-disorders/neurologic-examination/how-to-assess-reflexes) (MSD Manual Professional Edition, 2024); [Babinski reflex](https://medlineplus.gov/ency/article/003294.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [16.4 The Sensory and Motor Exams](https://openstax.org/books/anatomy-and-physiology-2e/pages/16-4-the-sensory-and-motor-exams) (OpenStax, Anatomy and Physiology 2e, 2022). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/babinski-sign/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/babinski-sign/