Piotrowski reflex

Of the Piotrowski reflex is a foot reflex of the tibialis anterior muscle. Physiologically, it is weak or nonexistent. An increased reflex movement can indicate neurological damage in the pyramidal tracts of the spinal cord.

What is the Piotrowski reflex?

The neurologist knows a number of symptoms as so-called pyramidal orbit signs that indicate damage to the pyramidal orbits. The pyramidal tracts are part of the pyramidal system that lies in the spinal cord and takes on important tasks in voluntary and reflex motor skills. The superordinate switching points of the pyramidal trajectories are the two central motor neurons that are connected by the trajectories.

A strong Piotrowki reflex is assessed as an unsafe pyramidal orbit sign. This is a reflex plantar flexion after a blow to the distal end of the tibialis anterior muscle (shin muscle). Plantar flexion is a flexion of the foot or toe towards the sole of the foot. It is like the movement that the foot makes on the accelerator of the car.

The Piotrowki reflex can also be triggered in healthy people, but is then usually hardly visible. Under pathological conditions it is intensified.

All plantar reflexes are extraneous reflexes. Your effectors and affectors are therefore not in the same organ. A polysynaptic interconnection triggers the reflex movements.

Function & task

The Piotrowki reflex is not a vital reflex and has already completely regressed or at least diminished in most people. Therefore, nowadays the reflex movement is mainly relevant in the context of the neurological reflex examination, during which it can take on 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 muscles of the lower leg. It originates from the lateral condyle and the upper half of the lateral tibia. Fibers of the interosseous membrane and the muscular 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 towards the foot. At the level of the foot, the tendon of the muscle attaches to the medial cuneiform bone and the first metatarsal bone. The muscle is innervated by the deep fibular nerve, which is connected to the segmental tracts L5 and S1. The nerve is a branch of the common fibular nerve that originates from the sciatic nerve. The deep fibular nerve is a mixed nerve and branches at the fork of the common fibular nerve.

After the anterior intermuscular cruris septum has been perforated, it extends below the extensor digitorum longus muscle in the medial and caudal direction, where it crosses the anterior surface of the interosseous crural membrane. In the middle of the lower leg, the nerve connects with the arteria tibialis anterior and accompanies this artery to the ankle. In terms of motor power, the deep fibular nerve supplies the tibialis anterior as well as 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 nerve path segments L5 and S1 mediate the motor reflex response. The affectors of the reflex movement are located in the distal end of the tibialis anterior muscle. The reflex arc is closed by the effectors, which reach back to the muculus tibialis anterior and supply it with motor.

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Illnesses & ailments

Since the Piotrowski reflex is only an uncertain pyramid orbit sign, its presence or absence cannot be used as a diagnostic tool without reservation. On the one hand, a foreign reflex such as the Piotrowski reflex can change physiologically with age 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 equipped with a physiologically strong Piotrowski reflex.

Both legs are examined for the reflex movement in the reflex examination. If the intensity of the relex response is significantly stronger on one leg than on the other, this can indicate a pyramidal lesion. Of course, the general picture of the patient also provides the framework for the diagnosis. If this picture is compatible with pyramidal damage and if there are other pyramidal trajectories in addition to the Piotrowski reflex, then pyramidal damage is a justifiable diagnosis. Pyramidal damage can occur as a result of trauma. Spinal cord tumors or spinal cord infarctions are also possible 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 patient's immune system attacks the body's own nerve tissue in 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 takes place in the pyramidal orbits, severe immobility can result. The motor skills of various limbs can be severely impaired by such inflammation. The symptoms depend on the location, size and aggressiveness of the inflammation.

Neurologically degenerative diseases such as ALS can also irreversibly damage the motor nervous system and the pyramidal tracts. In rare cases, masses in the spinal cord are the cause of pyramidal orbital signs. Such masses can be cysts or tumors of various degrees of malignancy.