<p begin="00:00:04.271" end="00:00:06.621" style="s2">- The following study is imaging</p>
<p begin="00:00:06.621" end="00:00:09.112" style="s2">of the Morton's neuroma.</p>
<p begin="00:00:09.112" end="00:00:12.663" style="s2">Anatomical landmarks<br />here are transverse image</p>
<p begin="00:00:12.663" end="00:00:16.830" style="s2">over the volar aspect or plantar<br />aspect of the MTP joints,</p>
<p begin="00:00:18.291" end="00:00:21.756" style="s2">just proximal to the articulating surface.</p>
<p begin="00:00:21.756" end="00:00:23.504" style="s2">In this illustration, we see a bulging</p>
<p begin="00:00:23.504" end="00:00:25.671" style="s2">of the interdigital nerve.</p>
<p begin="00:00:29.906" end="00:00:32.706" style="s2">At the level of the third<br />and fourth MTP joint,</p>
<p begin="00:00:32.706" end="00:00:37.160" style="s2">we see a hypoechoic space<br />representing a Morton's neuroma</p>
<p begin="00:00:37.160" end="00:00:41.137" style="s2">that is not quite accentuated<br />without dynamic stress.</p>
<p begin="00:00:41.137" end="00:00:45.295" style="s2">We'll highlight this<br />structure here in yellow,</p>
<p begin="00:00:45.295" end="00:00:47.903" style="s2">followed by a positive Mulder's sign,</p>
<p begin="00:00:47.903" end="00:00:52.282" style="s2">which is a squeezing of the<br />foot bringing the MTP joints</p>
<p begin="00:00:52.282" end="00:00:55.367" style="s2">together under dynamic stress as seen here</p>
<p begin="00:00:55.367" end="00:00:58.811" style="s2">with releasing of the metatarsal heads</p>
<p begin="00:00:58.811" end="00:01:01.252" style="s2">and forcing back together.</p>
<p begin="00:01:01.252" end="00:01:03.886" style="s2">Turning the probe back<br />to a long axis direction,</p>
<p begin="00:01:03.886" end="00:01:08.389" style="s2">we notice the hypoechoic<br />space is long and irregular.</p>
<p begin="00:01:08.389" end="00:01:11.871" style="s2">Using a heel to toe<br />maneuver with the probe</p>
<p begin="00:01:11.871" end="00:01:14.864" style="s2">will compress the soft tissue<br />surrounding the neuroma</p>
<p begin="00:01:14.864" end="00:01:19.770" style="s2">to further bring out the<br />differences in tissue interfaces.</p>
<p begin="00:01:19.770" end="00:01:21.613" style="s2">Here we have another example<br />of a Morton's neuroma</p>
<p begin="00:01:21.613" end="00:01:24.605" style="s2">highlighted here in yellow,<br />which is also further brought</p>
<p begin="00:01:24.605" end="00:01:28.688" style="s2">out by a positive Mulder's<br />sign or Mulder's test.</p>
<p begin="00:01:33.132" end="00:01:35.717" style="s2">Here's a less noticeable Morton's neuroma.</p>
<p begin="00:01:35.717" end="00:01:38.997" style="s2">Even when the Mulder's sign is applied,</p>
<p begin="00:01:38.997" end="00:01:40.914" style="s2">the difference in tissue interfaces</p>
<p begin="00:01:40.914" end="00:01:44.362" style="s2">is not clearly visible<br />until force is applied</p>
<p begin="00:01:44.362" end="00:01:46.228" style="s2">from the dorsal aspect of the foot</p>
<p begin="00:01:46.228" end="00:01:49.563" style="s2">with pressure downward<br />towards the probe's surface</p>
<p begin="00:01:49.563" end="00:01:51.363" style="s2">on the plantar aspect.</p>
<p begin="00:01:51.363" end="00:01:53.377" style="s2">Forcing these tissues together creates</p>
<p begin="00:01:53.377" end="00:01:56.377" style="s2">a more noticeable tissue interface.</p>