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Neurological foot exam
September 3, 2014 6:47 PM   Subscribe

Purpose of exam by a physician in which you lie on your back with your legs straight and extended with your feet/toes flexed towards your face? Then the doc will try to pull your feet down and towards him? And then the reflex tool is used on the inside of the heel? Google failed me on this one. And what is this exam called?

My feet didn't respond normally (very weak toes) and the doc said something about a disc or nerve issue in my back. Perhaps T1 and T2 but I don't recall. Also something about sciatica but I have had that a few times and don't feel that I have it now. Not looking for a diagnosis, just some insight. Thanks!
posted by futz to Health & Fitness (6 answers total)
 
Sciatica? If that were it you would have felt a hot pain when he tested your reflexes.

I do know that this was how I was tested for a tibial stress fracture and to rule out shin splints back in the day though.

Several other conditions can be diagnosed through this test which is probably why the internet chose to plead the 5th. :)

What other pains do you have? If you've been exercising and the pain has started with exercise there is a host of tests to isolate what they think it could be. Did they do an X-Ray? If it is a stress fracture it may or may not show up depending on where it is. Your doctor sounds like he was trying to distinguish nerve vs. bone vs. soft tissue injury pain. Legs are complicated, yo.
posted by floweredfish at 6:59 PM on September 3


Hey, good thing you're not looking for a diagnosis because I'm not a doctor! Just an amateur with a similar experience.

In my understanding, the deal is that you can test certain nerve functions by testing your peripheral limbs for strength, reflex responsiveness, pain, tingling, loss of sensation, etc. For example, a slipped disc or a pinched nerve, which is actually a neurological problem, could manifest as a symptom such as that in your leg, arm, fingers, toes, etc. I had a slipped disc once and the doc was very interested in whether I could feel everything in my fingers and still move my hands correctly (I could).

So, I don't know about the specific one with pushing/pulling on your feet, but that sounds like the same general category of test.
posted by Joey Buttafoucault at 6:59 PM on September 3


These are parts of the neurological examination:
-- Ankle jerk (Achilles) reflexes (S1, S2)
-- Dorsiflexion of the feet (L4, L5) and toes (L5, S1).
posted by drpynchon at 7:07 PM on September 3 [3 favorites]


drpynchon has good answers for you. In case it is not clear, the letters and numbers represent the nerves from your spine that are being tested by each part of the exam (L = lumbar, S = sacral)

However, I would just add that the part where they use a tool on the sole of your foot is a separate part of the exam looking for something called a "Babinski sign" or "Babinski/plantar reflex".
posted by treehorn+bunny at 7:54 PM on September 3 [2 favorites]


Thanks all. The tool was applied to the area between my ankle and heel on the inner foot. Not my sole. I wasn't very clear on that in my description.
posted by futz at 8:00 PM on September 3


I think it is what drpynchon said.

http://www.osceskills.com/e-learning/subjects/lower-limb-neurological-examination/

Scroll way down for picture of someone's foot being touched in area you describe. Description:

The ankle jerk is elicited by resting the patient’s leg on the bed with their hip laterally rotated. Pull the foot into dorsiflexion and hit the calcaneal tendon.

Further exploration reveals:
https://informatics.med.nyu.edu/modules/pub/neurosurgery/reflexes.html

L5/S1 Disc Prolapse
Pain along posterior thigh with radiation to the heel
Weakness on plantar flexion (may be absent)
Sensory loss in the lateral foot
Absent ankle jerk reflex


So, it was probably S1 that you heard them say? Because I believe the T1 and T2 dermatomes are in the arms and then the S1 and L5 cover the feet.

Of course if they did test you in your upper extremities, then they may have talked about T1 and T2 (more likely C5, etc.). :)

If they wondered about sciatica, it would make sense to test the areas of the S1 and L5 dermatomes. If you mentioned having it before, it's possible you could have it now so they would test for it this way because it may present in a different fashion each time.

If you don't have pain or whatever with a test, then they know to continue testing and looking for what is causing the problem.

I type reports for an orthopedic clinic, so I look this stuff up all day.
posted by AllieTessKipp at 9:36 PM on September 3 [2 favorites]


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