Fig. 1

a. “Huffing and puffing” sign. Excessive demonstrations of effort are illustrated in this man attempting to rise from a chair, disproportionate to any strength or sensory deficits. b. Psychogenic toe sign. Left: the clinician attempts to flex the extended first toe with little success but substantial pain. Right: upon vigorous dorsiflexion of toes 2–5, spontaneous plantar flexion of the first toe is observed. c. Fixed plantar flexion sign. A fixed foot in plantar flexion and inversion prevents weight bearing, and forces the use of an assistive device (walker or wheelchair). A magnified view of the patient’s right foot is shown on the right. d. Swivel chair sign. Above, patient displays a bizarre gait pattern. Below, same patient is able to successfully propel herself in the swivel chair