REIDER PART 2
34

294 Chapter 7_Lower Leg, Foot> and Ankle

Figurę 7-71. First metatarsal rise test. The arrow indicates the direction of the rise of the first metatarsal in responsc to external rotation of the lower leg.

Figurę 7-72. Mortons test. The arrows indicate the direction of the compre$sivc forces applied to the first and fifth metatarsal heads.

interdigital neuroma between the adjacent metatarsal heads. To perform Mortons test, the examincr grasps the heads of the first and fifth metatarsals and com-presses them together (Fig. 7-72). Further irritation of the nerve may be produced by reciprocally moving the first and fifth metatarsals up and down in opposite directions. If this compression of the metatarsal heads reproduces the patients characteristic pain, it is highly suggestive of the presence of an interdigital neuroma.

Occasionally, the examiner may appreciate a palpable click while compressing the metatarsal heads. This is known as Mulder*s click, and it is thought to be caused by a large neuroma bcing forced plantarly by the com-pressed metatarsal heads.

Dorsiflexion-Eversion Test

The dorsiflexion-eversion test is a very useful maneu-ver for eliciting the symptoms of tarsal tunnel syn-drome. To perform this test, the examiner places the patienfs ankle in a position of maximal dorsiflexion and evcrsion, while also dorsiflexing the metatarsopha-langeal joints. (Fig. 7-73) This places the tibial nervc on maximal stretch through the tarsal tunnel, and very reliably reproduces patients’ paresthesias, radiating pain, or numbness.    Figurę 7-73. Dorsiłlexion-eversion Test