Significance of a Nonresponsive Plantar Reflex in Neurological Dysfunction

Understanding Plantar Reflexes

The plantar reflex is designed to identify loss of protective sensation (LOPS) rather than early neuropathy, particularly in patients with diabetes, according to the American Diabetes Association 1, 2, 3
Normal plantar reflexes are part of a comprehensive neurological assessment that includes testing for vibration sensation, pinprick sensation, and other reflexes, as recommended by the American Academy of Pediatrics 4

In adults, diminished or absent plantar reflexes may suggest peripheral neuropathy, particularly in patients with diabetes, as stated by the American Diabetes Association 1, 3
The 10-g monofilament test should ideally be performed with at least one other assessment (pinprick, temperature or vibration sensation using a 128-Hz tuning fork, or ankle reflexes), according to the American Diabetes Association 2, 3
Absent monofilament sensation suggests loss of protective sensation (LOPS), while at least two normal tests (and no abnormal test) rules out LOPS, as recommended by the American Diabetes Association 3, 5

A nonresponsive plantar reflex should never be interpreted in isolation and requires a comprehensive neurological examination to identify the underlying cause, as stated by the American Academy of Pediatrics and the American Diabetes Association 2, 4
In diabetic patients, increase the frequency of foot examinations based on risk stratification, as recommended by the American Diabetes Association 1
For patients with loss of protective sensation, provide education on proper foot care and appropriate footwear, according to the American Diabetes Association 3, 8
Consider referral to a neurologist if the nonresponsive reflex is accompanied by other concerning neurological findings, as recommended by the American Academy of Pediatrics 4

Nonresponsive plantar reflexes may be part of diabetic peripheral neuropathy and loss of protective sensation, as stated by the American Diabetes Association 1, 2
Patients with LOPS should be educated on ways to substitute other sensory modalities (hand palpation, visual inspection) for surveillance of early foot problems, according to the American Diabetes Association 6
Patients with neuropathy and nonresponsive reflexes are at higher risk for foot ulcers and require more frequent foot assessments, as recommended by the American Diabetes Association 1, 7