A New Method of Eliciting Pyramidal Tract Impairment in Adults

Background: To suggest a new way of eliciting pyramidal tract dysfunction in adults since the most widely utilized plantar reflex, which is the Babinski reflex, has limitations with different reliability and consistency among different examiners.    Materials and methods: 168 adult subjects were examined for the new sign in addition. It consists of just an observation of the patient’s feet and toes in a conscious patient looking for the extension of the great toe along with fanning, spreading and plantar flexion of the small toes either at rest or when patient elevates one leg up at a time.   Results: We were able to observe the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients with impairment of pyramidal tract. The specificity was 94% while the sensitivity was 96%.   Conclusion: Pyramidal tract lesion in adults can be elicited by this new test that observes the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients. We suggest this sign as a complement to established signs like Babinski reflex.

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Biomechanical Impact of FHL Tendon Harvest on Forefoot and Great Toe Push-off Strength and Its Correlation to Knot of Henry Crossover Variation

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00034 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0003

Author(s):

Timothy Charlton ◽

Danielle Thomas ◽

David Thordarson ◽

Melodie Metzger ◽

Trevor Nelson

Keyword(s):

Repeated Measures ◽

Plantar Flexion ◽

Tissue Bank ◽

Flexor Hallucis Longus ◽

Type I ◽

Type Ii ◽

Great Toe ◽

Type Iv ◽

Loading Patterns ◽

Type V

Category: Midfoot/Forefoot Introduction/Purpose: The flexor hallucis longus (FHL) tendon is commonly used for tendon transfers in reconstructive Achilles tendon procedures. A subset of patients who undergo this procedure complain of first great toe weakness and loss of push off strength after FHL tendon transfer. Despite the frequency of this procedure, there is currently little information available to surgeons to help understand this potential complication. Therefore, the objective of this biomechanical cadaveric study was to quantify plantar flexion strength after FHL harvest and correlate it to variations in anatomy to determine if distinct tendon crossover patterns at the Knot of Henry are more likely to lead to forefoot weakness. Methods: Cadaveric specimens were procured from an approved tissue bank. The proximal end of the tibia was potted and secured to the Mechanical Testing System. A pressure mapping system was used to measure plantar force though the great toe and lesser toes. The Achilles, FHL, and flexor digitorum longus (FDL) tendons were attached to linear actuators for load application. Pressure under the toes was measured with the Achilles alone, Achilles with FHL, Achilles with FDL, and Achilles with both FHL and FDL. The resultant loading patterns were recorded in the greater and lesser toes and compared between the different states. After biomechanical testing, all specimens were carefully dissected and the tendinous slips between the FHL and FDL were documented and classified based on a previously determined system (Types I-V, LaRue; Edama) Functional and anatomical relationship between the classification type and loading patterns were statistically analyzed using repeated measures ANOVA. Results: 23 specimens (13M / 10F) with a mean age of 71 years (range: 54-90) were used in this study. 61% were anatomically classified as type I, followed by type II (26%), IV (9%), and type V (4%), and type III (0%). Simulated FHL harvest in type I specimens resulted in a 29% decrease in great toe flexion pressure and an 21% decrease in total forefoot flexion pressure, p<0.05. In type II feet, FHL harvest led to a greater reduction in flexion pressure in the great toe (34%) and forefoot (25%), p<0.05. Type IV specimens also had a decrease in flexion pressure in both the great toe (21%) and forefoot (15%), p<0.05. Type V specimens trended similar to type I specimens. Conclusion: This study is the first to quantify loss of great toe and lesser toe flexion pressure after FHL harvest. In addition, it is the first to correlate these losses to variations in anatomic crossover patterns at the Knot of Henry. Specimens classified as type II had the greatest reduction in flexion pressure, followed by type I and type IV. This information is clinically important for preoperative discussions about post-surgical expectations and surgical planning.

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Knot of Henry Variation and the Effect on Plantar Flexion Strength

Foot & Ankle International ◽

10.1177/1071100719875229 ◽

2019 ◽

Vol 41 (1) ◽

pp. 94-100

Author(s):

Danielle Thomas ◽

David Thordarson ◽

Trevor J. Nelson ◽

Timothy P. Charlton ◽

Samuel Eberlein ◽

...

Keyword(s):

Tendon Transfer ◽

Plantar Flexion ◽

Biomechanical Study ◽

Flexor Hallucis Longus ◽

Great Toe ◽

Average Decrease ◽

Pressure Mapping ◽

Force Reduction ◽

Flexor Digitorum ◽

Patients Experience

Background: The flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons are commonly used for tendon transfer in reconstructive foot and ankle procedures. Some patients experience great toe weakness and loss of push-off strength. The objective of this biomechanical study was to quantify plantarflexion force after FHL and FDL harvest and correlate it to variations in tendon crossover patterns at the knot of Henry to determine if specific patterns have an increased tendency toward forefoot weakness. Methods: Simulated loads through the Achilles, FHL, and FDL were applied to cadaveric specimens while plantarflexion force was measured using a pressure mapping system. Force was recorded with the FDL and FHL unloaded to simulate tendon transfer. Afterward, specimens were dissected to classify the tendinous slips between the FHL and FDL based on a previously determined system. Functional and anatomical relationships between the classification type and loading patterns were analyzed. Results: There were no statistical differences between the tendon crossover patterns in forefoot force reduction after FHL or FDL harvest. Average decrease in great toe and total forefoot pressure after FHL harvest was 31% and 22%, respectively. Average decrease in lesser toe and total forefoot push-off force after FDL harvest was 23% and 9%, respectively. Conclusion: This study quantified loss of plantarflexion force after simulated FHL and FDL harvest and correlated these losses to variations in anatomic crossover patterns at the knot of Henry. Variations at the knot of Henry do not contribute to differences in forefoot weakness. Clinical Relevance: The decrease in forefoot pressure seen here would help explain the clinical scenario where a patient does note a loss of great toe strength after FHL transfer.

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The Neurological Assault on the Great Toe (1893–1911)

Scottish Medical Journal ◽

10.1177/003693308703200215 ◽

1987 ◽

Vol 32 (2) ◽

pp. 57-59 ◽

Cited By ~ 1

Author(s):

R. Grant

Keyword(s):

20Th Century ◽

Clinical Relevance ◽

Early 20Th Century ◽

Clinical Neurology ◽

Great Toe ◽

Plantar Reflex

The late 19th/early 20th century heralded a period in neurology when there was claim and counter claim about the founders of new reflex movements of the great toe. The cutaneous plantar reflex is undoubtedly one of the most important signs in clinical neurology, and there have been several methods described of eliciting this sign, each with its own eponymous name. This article reviews the background to these claims and the contribution of the various authors, to the discovery, clinical relevance and ease of eliciting reflex movements of the great toe.

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OBSERVATIONS ON THE EXTENSOR PLANTAR REFLEX AND ITS RELATIONSHIP TO THE FUNCTIONS OF THE PYRAMIDAL TRACT

Brain ◽

10.1093/brain/82.3.297 ◽

1959 ◽

Vol 82 (3) ◽

pp. 297-320 ◽

Cited By ~ 22

Author(s):

RUSSELL BRAIN ◽

MARCIA WILKINSON

Keyword(s):

Pyramidal Tract ◽

Plantar Reflex

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Amputation of the Great Toe

Foot & Ankle ◽

10.1177/107110078100100606 ◽

1981 ◽

Vol 1 (6) ◽

pp. 333-337 ◽

Cited By ~ 21

Author(s):

Norman K. Poppen ◽

Roger A. Mann ◽

Mark O'Konski ◽

Harry J. Buncke ◽

Melvin H. Jahss

Keyword(s):

Plantar Flexion ◽

Metatarsophalangeal Joint ◽

Great Toe ◽

X Ray ◽

First Metatarsal ◽

The One ◽

Everyday Function

Four patients who had undergone reimplantation of the great toe to create a thumb were studied. The follow-up period ranged from 29 to 62 months. In all cases, the great toe was disarticulated at the metatarsophalangeal joint. The patients felt their feet functioned at approximately 85% of normal, and none had any significant complaint of metatarsalgia. The one patient who participated in sports after the surgery noted that it was difficult to “push off” moving away from the involved foot. X-ray examination demonstrated retraction of the sesamoids, which accounted for the increased plantar flexion of the first metatarsal shaft. The second metatarsophalanageal joint drifted into varus an average of 8°. The Harris mat demonstrated that there was an increase in weightbearing beneath the second and third metatarsal heads. It appears as though, on the basis of this study, the loss of the great toe in this manner does not significantly affect the normal everyday function of an individual's foot.

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The Great Toe (Babinski) Phenomenon: A Contribution to the Study of the Normal Plantar Reflex Based on the Observation of One Hundred and Fifty-Six Healthy Individuals

Boston Medical and Surgical Journal ◽

10.1056/nejm190101241440402 ◽

1901 ◽

Vol 144 (4) ◽

pp. 81-83

Author(s):

MORTON PRINCE

Keyword(s):

Healthy Individuals ◽

Great Toe ◽

Plantar Reflex

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Reversed Chaddock method: a new method to elicit the upgoing great toe.

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.49.11.1321 ◽

1986 ◽

Vol 49 (11) ◽

pp. 1321-1321 ◽

Cited By ~ 4

Author(s):

K Tashiro

Keyword(s):

New Method ◽

Great Toe

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Selective Sampling and Orientation of Non-Homogeneous Tissues

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100100238 ◽

1968 ◽

Vol 26 ◽

pp. 98-99

Author(s):

C. C. Clawson ◽

L. W. Anderson ◽

R. A. Good

Keyword(s):

Electron Microscopy ◽

Electron Microscope ◽

Light Microscopy ◽

Random Sampling ◽

New Method ◽

Microscope Examination ◽

Small Areas ◽

Selective Sampling ◽

Large Numbers ◽

Specific Orientation

Investigations which require electron microscope examination of a few specific areas of non-homogeneous tissues make random sampling of small blocks an inefficient and unrewarding procedure. Therefore, several investigators have devised methods which allow obtaining sample blocks for electron microscopy from region of tissue previously identified by light microscopy of present here techniques which make possible: 1) sampling tissue for electron microscopy from selected areas previously identified by light microscopy of relatively large pieces of tissue; 2) dehydration and embedding large numbers of individually identified blocks while keeping each one separate; 3) a new method of maintaining specific orientation of blocks during embedding; 4) special light microscopic staining or fluorescent procedures and electron microscopy on immediately adjacent small areas of tissue.

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