Lower Limb Neurological Examination

            1. Observe with the patient undressed : nystagmus, wasting and hemiparesis

            2. Assess tone for hyper or hypotonia

            3. Power:
             

            •             Lift the leg up (L1 & 2)
            •             Bend the knee (L5, S1 & 2)
            •             Straighten the leg (L3 & 4)
            •             Bend the foot down ( S1)
            •             Cock up the foot (L4 & 5)

            4. Co-ordination (heel-shin)

            5. Tendon reflexes (knee and ankle)

            6. Plantar responses (Babinski's sign)

            7. Gait (walk and heel-to-toe)

            8. Romberg's sign
             
             

            Like the upper limb examination, most common cases are:

            •     hemiplegia with homonymous hemianopia /              quadrinopia
            •     incoordination with multiple sclerosis
            In addition, the foot is often presented for examination in a patient with diabetic retinopathy. Look out for ischamia and/or peripheral neuropathy
             

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