Lower Limb Neurological Examination

The lower limb examination is another skill to elicit neurological signs i.e nerve problems that supply the legs and feet.  Patients may present with a number of complaints including altered sensation e.g. pins and needles or numbness or loss of power of a limb, it may be intermittent such as multiple sclerosis or permanent such as in motor neurone disease.  Neuropathies can also occur and can be mono such as foot drop or poly such as “glove and stocking” which can occur in diabetes mellitus.

A full neurological examination therefore includes assessment of both the motor and sensory systems of the legs.  In exams you may be asked to focus on one part i.e. sensory or motor, however this guide will include both.

See Upper Limb Neurological Examination for how to perform this on the upper limbs.

Subject steps

  1. As with all examinations, the best method is your own – one with which you are comfortable and familiar. The one explained here takes the following format:

    • Tone
    • Power
    • Reflexes
    • Function
    • Sensation
  2. Wash your hands, introduce yourself to the patient and clarify their identity.  Explain what you would like to do and obtain consent

  3. Ideally the patient should have their lower body exposed, although for the purpose of the exam the patient will likely be in shorts.  Begin by observing the patients legs, looking for any muscle wasting, fasciculations or asymmetry.

  4. Reflexes

    There are three reflexes in the lower limb:

  5. Finally, with their leg out straight and resting on the bed, run the end of the handle of the tendon hammer along the outside of the foot. This gives the plantar reflex. An abnormal reflex would see the great toe extending.

  6. If you struggle with any of these reflexes, asking the patient to clench their teeth should exaggerate the reflex.

  7. Sensation

    You should test light touch, pin prick, vibration, and joint position sense, or proprioception.

  8. Allow the patient to dress and thank them.  Wash your hands and report your findings to the examiner.