The Piotrowski reflex is a foot reflex of the tibialis anterior muscle. It is physiologically present only weakly or not at all. Increased reflex movement may indicate neurologic damage in the pyramidal tracts of the spinal cord.
What is the Piotrowski reflex?
The Piotrowki reflex occurs after a blow to the distal end of the tibialis anterior muscle (shin muscle). Known as pyramidal tract signs, neurologistsIn are aware of a number of symptoms that indicate damage to the pyramidal tracts. The pyramidal tracts are a part of the pyramidal system, which is located in the spinal cord and plays important roles in voluntary and reflex motor function. The superior switching sites of the pyramidal tracts are the two central motor neurons, which are connected by the tracts. A strong Piotrowki reflex is evaluated as an uncertain pyramidal tract sign. It is a reflex plantar flexion following a blow to the distal end of the tibialis anterior muscle (shin muscle). Plantar flexion is a flexion of the foot or toes in the direction of the sole of the foot. It is similar to the movement made by the foot on the accelerator pedal of the car. The Piotrowki reflex can also be triggered in healthy people, but it is usually hardly visible. Under pathological conditions it is intensified. All plantar reflexes are external reflexes. Their effectors and affectors are therefore not located in the same organ. Polysynaptic circuitry triggers the reflex movements.
Function and task
The Piotrowki reflex is not a vital reflex and has already completely regressed or at least diminished in most people. Therefore, reflex movement is nowadays mainly relevant in the context of neurologic reflex examination, during which it can play the role of a weak diagnostic tool. The Piotrowski reflex is a reflex of the tibislis anterior muscle. This muscle is a long, spindle-shaped skeletal muscle that belongs to the lower leg musculature. It takes its origin with the condyle lateralis and the upper half of the lateral tibia. Fibers of the interosseous membrane and muscle septum accompany it and separate it from the extensor digitorum longus muscle. The tendon of the muscle runs under the retinaculum extensorum superius on the medial side of the ankle toward the foot. At the level of the foot, the tendon of the muscle attaches to the os cuneiforme mediale and the os metatarsale I. The muscle is innervated by the profundal fibular nerve, which is connected to the L5 and S1 segmental tracts. The nerve is a branch of the common fibular nerve, which originates from the sciatic nerve. The profundal fibular nerve is a mixed nerve and branches at the bifurcation of the common fibular nerve. After piercing the anterior intermuscular crural septum, it extends below the extensor digitorum longus muscle in the medial and caudal directions, where it crosses the anterior surface of the interosseous crural membrane. In the midline of the lower leg, the nerve joins the anterior tibial artery and accompanies this artery to the ankle joint. Motorically, the profundal fibular nerve supplies the tibialis anterior muscle in addition to many other muscles of the lower leg. Its sensitive parts supply the skin of the toes. The Piotrowski reflex is triggered via the nevus fibularis profundus. The L5 and S1 nerve pathway segments mediate the motor reflex response. In the distal end of the tibialis anterior muscle lie the effectors of reflex movement. The reflex arc is closed by the effectors, which extend back to the anterior tibial muculus for motor supply.
Diseases and disorders
Because the Piotrowski reflex is only an uncertain pyramidal pathway sign, its presence or absence cannot be used unconditionally as a diagnostic tool. For one thing, an extraneous reflex such as the Piotrowski reflex may undergo age-related physiological changes and thus simply become exhausted after a certain age. On the other hand, some people basically do not have the Piotrowski reflex, while others are endowed with a physiologically strong Piotrowski reflex. Both legs are tested for reflex movement in the reflex examination. If the intensity of the reflex response is significantly stronger on one leg than the other, then this may indicate a pyramidal lesion. Of course, even then, the general picture of the patient provides the framework for the diagnosis.If this picture is consistent with pyramidal damage and other pyramidal tract signs are present in addition to the Piotrowski reflex, then pyramidal damage is a defensible diagnosis. Pyramidal damage may present as a result of trauma. Spinal cord tumors or spinal cord infarctions are also conceivable causes. Neurological diseases may also be associated with damage to the pyramidal tracts. The best known of these diseases is the autoimmune disease multiple sclerosis. The immune system of the patient attacks the body’s own nerve tissue of the central nervous system through incorrect programming. These immunological attacks cause inflammation in the nerve tissue and thus destroy the nerve cells. When this process occurs in the pyramidal tracts, severe immobility can result. Motor function of various limbs can be severely affected by such inflammation. The symptoms depend in detail on the localization, size and aggressiveness of the inflammation. Neurological degenerative diseases such as ALS can also irreversibly damage the motor nervous system and pyramidal tracts. In rare cases, spinal cord space-occupying lesions are the cause of pyramidal tract signs. Such space-occupying lesions may be cysts or tumors of various degrees of malignancy.
