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Mulder's sign/click - What, Where, When, How?

Discussion in 'General Issues and Discussion Forum' started by wdd, Jul 27, 2013.

  1. wdd

    wdd Well-Known Member

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    Mulder's sign

    Mulder’s Sign is a physical exam finding associated with Morton's neuroma, which may be elicited while the patient is in the supine position on the examination table. The pain of the neuroma, as well as a click, can be produced by squeezing the two metatarsal heads together with one hand, while concomitantly putting pressure on the interdigital space with the other hand. With this technique, the pain of the Morton's neuroma will be localized strictly to the plantar surface of the involved interspace, with paresthesias radiating into the affected toes.



    Last edited by a moderator: Sep 22, 2016
  2. Admin2

    Admin2 Administrator Staff Member

  3. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    A poor demonstration - the "click" elicited was obviously from the ball-point pen being applied repeatedly to the plantar forefoot.
  4. wdd

    wdd Well-Known Member

    I wonder if the youtube video is a student joke and I find the wikipedia description less than comprehensive?

    I don't know whether the click is pathognomonic of Morton's neuroma and I not I am not sure what is actually being forced between the metatarsal heads but my own technique for maximising the probability o fproducing Mulder's click is as follows:

    Using the thumb of one hand, from the plantar aspect, press upwards between the affected metatarsal heads, in an attempt to force the 'neuroma' between the metatarsal heads. Then press the metatarsal heads together. If the 'neuroma' has been forced between the met. heads this should produce pain.

    On some occasions the 'neuroma' immediately spings out from between the metatarsal heads eliciting the 'click'. On other occasions it doesn't. Placing the thumb or forefinger of the free hand in between the affected metatarsal heads on the dorsal surface and slowly pushing down, in an attempt to push the 'neuroma' from between the metatarsal heads, may elicit the 'click'. If not slowly release the constrictive pressure on the metatarsal heads while maintaining the dorsal to plantar pressure between the affected metatarsal heads. As the constrictive pressure between the metatarsal heads is released and the downward pressure between the affected met. heads is maintained the 'click' may be elicited.

    Patients can be taught to apply dorso-plantar pressure between the affected metatarsal heads to push the 'neuroma' out from between the met. heads to releave the pain.

    Any variations on the theme?


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