In Babinski test, what does upward toe indicate?

• A. Up (abnormal, considered positive test)
• B. Down (normal finding)
• C. No movement
• D. Flexion of toes

Answer: (A)

A positive Babinski sign is indicated by dorsiflexion of the big toe with spreading (fanning) of the other toes when the sole is stroked. In adults, this upward toe movement is abnormal and points to dysfunction of the corticospinal (upper motor neuron) pathways. Normally, the toes curl downward (plantarflex) in response. The upward response reflects an intact but immature or damaged UMN pathway in which the normal inhibitory control over extensor muscles is lost. In infants this upward response can be normal due to immature myelination, but in adults it suggests an upper motor neuron lesion, such as after stroke, trauma, or certain neurodegenerative processes. Downward toe response, lack of movement, or simple toe flexion do not indicate this UMN sign.