Pathophysiology of the Tonic Innervation Phenomenon in the Foot

Landau, William M.; Clare, Margaret H.

doi:10.1001/archneur.1966.00470150030006

Cited by 8 publications

(1 citation statement)

References 15 publications

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“…Fur¬ ther, "cutaneous stimuli, tactile or painful have no effect, and the reflex movement that may result from such stimulation (Riddoch and Buzzard) bears no resemblance to the ordinary associated reaction now under dis¬ cussion." A strongly performed Jendrassik or Val¬ salva maneuver induced a prompt postural synergy of the left foot and toes which was in all respects identical to the abnormal pos¬ turing described earlier in response to cuta¬ neous and painful stimulation (Figs 2, cen¬ ter right, 3). By exerting traction on the toe flexors once these were activated by either maneuver, it was possible to maintain a grasping reaction of the toes indefinitely.…”

Section: Effects Effects Of the Jendrassik And Valsalvasupporting

confidence: 67%

The Tonic Foot Response

Cohen¹,

Iannone²

1967

Archives of Neurology

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toes which continues for many seconds after withdrawal of an evoking stimulus is occasionally observed in patients with diffuse brain lesions or focal lesions involving the frontal lobe. This response has been designated by various authors as the "grasp reflex of the foot,"1 the "tonic foot response,"2 or the "tonic innervation phenomenon in the foot"3 emphasizing the involuntary quality, prolonged duration, and flexor direction of the abnormal motor synergy.The site and modality of stimulation which is adequate to evoke the tonic foot response is still unclear. Brain and Curran1 stated that the appropriate stimulus is light pressure on the distal plantar surface of the foot or toes. Goldstein2 reported that stationary tactile plantar stimulation, particularly if intense or painful, was adequate to induce the flexor synergy; and in one of his seven cases, stimulation of the contralateral plantar surface also evoked the response. Both earlier descriptions suggested that stretch of the toe flexor tendons could aug¬ ment and prolong the flexor synergy, but Landau and Clare3 could not find any evi¬ dence for a proprioceptive component of the tonic foot response in their well studied case. In this regard, Seyffarth and Denny-$ Brown4 could find no instance of an asso¬ ciated tonic foot response in their extensive investigation of the grasp reflex in the hand, even in those cases showing an associated well developed grasp reflex of the foot.We wish to describe an unusual case of a relatively isolated and symptomatic tonic foot response, not only because of the appar¬ ent rarity of this condition, but to illustrate the difficulties of simple reflexological analy¬ sis in conditions where an "adequate stimu¬ lus" cannot be unequivocally specified, and in which the motor synergy itself may be construed as one of several possible reflex automatisms. The effects of peripheral nerve block, cutaneous cooling, and barbiturate administration are also reported. Report of a CaseThe patient was a right-handed 43-year-old housewife who was referred to us in 1964. In 1948, she was informed by her family physician that she was hypertensive, but no studies were performed and no treatment instituted. In Feb¬ ruary 1961, following a five-day period of dif¬ fuse throbbing headache, she experienced the sudden onset of numbness and paralysis of the left arm and leg. There was no alteration in her level of consciousness or any exacerbation of her headache. Several hours later, she was seen by her physician, who noted the presence of a left hemiparesis and hemisensory defect. The blood pressure was 165/110 mm Hg. The pa¬ tient refused hospitalization and was treated at home with bed rest and hydrochlorothiazide and reserpine (Hydropres). Her left hemipare¬ sis improved over the following 24 hours, but she continued to note paraesthesia in the left limbs and trunk. Several days later, she con¬ sented to hospitalization, and at this time a lumbar puncture was normal. Skull x-ray films were normal. Attempted right carotid angiography resulted in...

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Section: Effects Effects Of the Jendrassik And Valsalvasupporting

confidence: 67%