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The Babinski reflex is part of the routine neurological examination to evaluate the integrity of the corticospinal tract. However, in settings where patients withdraw with plantar stimulation, or if there is a lesion on the lateral plantar aspect of the foot, evaluation of the Chaddock reflex offers a reasonable alternative to the Babinski reflex. Both the Babinski and Chaddock reflex test the integrity of the corticospinal tract. When a lesion occurs anywhere along this corticospinal tract, the examiner may obtain a positive reflex. The examiner watches for dorsiflexion (upward movement) of the big toe and fanning of the other toes. This is referred to as a "positive reflex," or one may state that the "reflex is present." When there is a downward deviation of the toes, this means the reflex is absent. This activity reviews the indications, contraindications, performance, and interpretation of the Chaddock reflex and highlights the role of the interprofessional team in assessing patients with neurological deficits. Objectives: Outline the indications for the evaluation of the Chaddock reflex. Describe the technique involved in evaluating the Chaddock reflex. Describe the clinical relevance of a positive Chaddock reflex. Explain the importance of a well-coordinated interprofessional team in the care of patients undergoing Chaddock reflex evaluation to assess the integrity of the corticospinal tract. Access free multiple choice questions on this topic.

Charles Gilbert Chaddock introduced the External Malleolar sign as an alternative to Babinski reflex in 1911.[1] This was later referred to as Chaddock reflex. Kisaku Yoshimura described a very similar sign in 1906 in the Japanese medical literature as a variation on the Babinski sign.[2] Both the Chaddock reflex and the Babinski reflex test the integrity of the corticospinal tract (CST). Both reflexes are easy to elicit and do not require significant cooperation from the patient, and therefore can be performed in patients who cannot fully cooperate with the neurological exam. The Babinski reflex is more commonly utilized as a part of the routine neurological exam. However, alternatives such as Chaddock sign can be employed when the patient exhibits a significant withdrawal response to plantar stimulation when performing the Babinski reflex.[3]

The emergency department physician, neurology nurses, neurologist, internist, and therapists often perform a neurological exam. To test for the integrity of the CST, the Babinski reflex is often performed. However, when the Babinski is not possible, the Chaddock reflex is an alternative. It is important to remember that the validity of the Chaddock reflex has never been tested in large clinical studies.[5][8][9][10] The reflex was introduced decades ago and it is sporadically used. A stroke or spinal cord injury should never be confirmed or refuted on the basis of the Chaddock reflex. An imaging test should always be done to confirm the CNS pathology.