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Mulder sign is a clinical test used to examine causes of metatarsalgia associated with Morton neuroma. It has high specificity (100%) but relatively low sensitivity (62%) 2. See the ultrasound correlate described separately: sonographic Mulder sign.
With one hand, clasp the metatarsal heads between the thumb and fingers or thenar eminence and fingers. Place the thumb of the other hand on the plantar surface of the foot in the intermetatarsal space at the site of the suspected neuroma. Squeeze the metatarsal heads together with one hand and concomitantly exert pressure on the interdigital space with the thumb of the other hand.
You may feel a mass displace towards the plantar surface of the foot as you squeeze the metatarsal heads together. The mass may be compressed between the metatarsal heads before it is displaced which is associated with the characteristic pain and coinciding with a palpable click as the lesion escapes the intermetatarsal space 1.
Sometimes an audible click may be heard.
History and etymology
The eponymous Mulder sign was first described by Dutch orthopedic surgeon Jacob D Mulder in 1951 3.
- 1. Torriani M, Kattapuram SV. Technical innovation. Dynamic sonography of the forefoot: The sonographic Mulder sign. (2003) AJR. American journal of roentgenology. 180 (4): 1121-3. doi:10.2214/ajr.180.4.1801121 - Pubmed
- 2. Mahadevan D, Venkatesan M, Bhatt R, Bhatia M. Diagnostic Accuracy of Clinical Tests for Morton's Neuroma Compared With Ultrasonography. (2015) The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 54 (4): 549-53. doi:10.1053/j.jfas.2014.09.021 - Pubmed
- 3. MULDER JD. The causative mechanism in morton's metatarsalgia. (1951) The Journal of bone and joint surgery. British volume. 33-B (1): 94-5. Pubmed