1. Introduction
The lower limb neurological examination assesses motor, sensory and reflex function of the lumbar and sacral roots, peripheral nerves and relevant upper motor neurone pathways.
2. Inspection and tone
With the patient lying on the bed, inspect for wasting, fasciculation, asymmetry, abnormal posture, foot deformity, contracture and involuntary movement. Assess tone at the hip, knee and ankle and check for clonus if tone is increased.
3. Power
Assess power systematically using the MRC scale where relevant. Useful muscle groups include hip flexion, knee extension, knee flexion, ankle dorsiflexion, great toe extension and ankle plantarflexion.
4. Reflexes and coordination
Assess the knee jerk and ankle jerk, comparing side to side. Assess the plantar response. Coordination is commonly assessed with the heel to shin test.
5. Sensation, gait and completion
Assess light touch over key dermatomes or peripheral nerve territories. If the patient is able to stand, inspect gait, including normal gait, heel walk, toe walk and tandem gait if appropriate. To complete the examination, assess the lumbosacral spine and consider cranial nerve or upper limb examination if a broader neurological lesion is possible.
Preparation
Inspection
Tone
Power
Reflexes
Coordination
Sensation
Gait
Completion