Ankle & Foot
Neurological & Vascular
Evidence: suggestive
Mulder's Sign Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing Morton's Neuroma (interdigital neuroma), typically between the 3rd and 4th toes.
How to Perform
- Position: Patient sits or lies supine.
- Action: Squeeze the metatarsal heads together with one hand (transverse arch compression).
- Palpation: With the other hand, apply pressure to the interspace between the toes and push upwards from the sole.
Interpretation of Results
- Positive Test: A distinct "click" is felt or heard, often accompanied by pain that reproduces the patient's symptoms.
Diagnostic Accuracy
- Specificity: High (93-100%) for Neuroma.
Clinical Context & Limitations
The Mulder's Sign should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Ankle & Foot region, combining the Mulder's Sign with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment (7th ed.). Elsevier.
