Striatal Toe

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A “striatal toe” (dystonic toe) is tonic extension of the great toe that occurs in extrapyramidal disease, particularly conditions affecting the striatum. It resembles the great toe extension of Babinski’s plantar sign but is tonic and sustained, not accompanied by fanning of the toes and occurs without plantar stimulation. The striatal toe has been referred to as the pseudo-Babinski sign. The extended toe may occur in isolation or as part of a foot dystonia that includes ankle inversion, arching of the sole and flexion of the other toes (striatal foot). In the Bajonet posture, the extension of the great toe occurs along with hyperflexion and hyperpronation of the hands and feet and is seen in some basal ganglia disorders.

In this 27 year old man with a 10 year history of Wilson’s disease, the great toe was tonically extended at rest, without any sort of foot stimulation, and the other elements of foot dystonia were not present.

References

Campbell WW. Clinical signs in neurology : a compendium. Philadelphia: Wolters Kluwer Health, 2016.

Campbell WW. DeJong's the neurologic examination, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.

Kumar S, Reddy CR, Prabhakar S. Striatal toe. Ann Indian Acad Neurol 2013;16:304-5.

Winkler AS, Reuter I, Harwood G, et al. The frequency and significance of ‘striatal toe’ in parkinsonism. Parkinsonism Relat Disord 2002;9:97–101.