Puusepp's sign- clinical significance of a forgotten pyramidal sign

Objectives: The pyramidal signs in the lower extremity are divided into three groups: (1) Babinski's group characterised by dorsoflexion of the great toe. This includes among others the signs of Babinski, Chaddock and Oppenheim, (2) pyramidal signs marked by plantar flexion of the toes (e.g. the signs of Rossolimo, Mendel-Bechterew, Zhukovski), (3) synkinetic movements such as Marie-Foix's and Strümpell's phenomena. Puusepp's sign described in 1923 by the outstanding Estonian neurologist and neurosurgeon Ludvig Puusepp (1875–1942) belongs to none of these three groups. Its eliciting does not differ from that of…