“Striatal Toe Sign”: False-Positive “Extensor Plantar Response” in Dystonia

Plantar response is a nociceptive protective reflex elicited classically by the Babinski method. This method involves stimulation of the sole from the posterolateral aspect, advancing forward and medially up to the ball of the great toe. A normal response would be flexor, in which all the toes including the great toe flex.1 The abnormal response is termed as "extensor toe sign," which is characterized by extension of the great toe and fanning of all other toes. This abnormal response is seen in presence of corticospinal (pyramidal tract) dysfunction as a result of either physiologic immaturity in infancy or pathology of the tract (upper motor neuron), anywhere from the motor cortex to the spinal cord anterior horn cell level.

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