Ball of the Foot Pain
Mulder’s Click Test [Best Morton’s Neuroma Squeeze TEST]
Mulder’s Click Test is the #1 most popular physical exam test to diagnose morton’s neuroma. #2 is Sullivan’s Sign, so treat is 100% properly!
- Morton’s neuroma pain can be improved with a few simple treatment changes.
- We are foot doctors & we see this problem get better almost every day.
- The goal is to solve this problem without medication or surgery if at all possible.
So, let’s GO!
- Metatarsalgia: which means generalized foot pain without a specific cause.
- Second toe capsulitis: this is the inflammation of the second toe joint capsule.
- Capsulitis is related to hammertoe formation, and can lead to a plantar plate tear. There is some overlap between these three disorders. As they get worse tearing and ligament damage can occur.
- Morton’s neuroma: this is the damage and inflammation to the nerves between and underneath the metatarsal joints.
- Fat pad atrophy of the ball of the foot: this is the loss of cushioning in the ball the foot.
So, click on the photo gallery to see the specific causes of your ball of the foot pain!
Click on the photo gallery to see the specific causes of your ball of the foot pain!
Mulder’s Click Test [Best Morton’s Neuroma Squeeze Test] Overview:
- Mulder’s Click Test is a podiatrist or foot doctor technique designed to test if a patient is suffering from a condition known as Morton’s Neuroma.
- This physical examination tests if there is a clicking noise or a shooting nerve pain caused by squeezing the bases of the toes together.
- The idea is to squeeze your metatarsals from side to side and see if the nerve in the middle clicks or squeezes.
Causes of Morton’s Neuroma:
- The most common cause of neuroma and neuroma formation is too much pressure in the ball of the foot.
- As this happens for too long the nerves can become very sore and swollen.
- If this happens for a very long time, scar tissue or a Morton’s neuroma can develop.
- This usually occurs between the 3rd and 4th metatarsals, but it can happen in other areas of the foot.
Symptoms of Morton’s Neuroma:
Causes of Morton’s Neuroma Include:
- Burning .
- Sharp Pain.
- Shooting Pain.
- 80% of the time in the 3rd to 4th toes.
- 20% of the time between the 2nd and 3rd toes.
- Pain on weight bearing.
- “Clicking of the toes” in that area.
- Feeling of a “pebble” in that area.
- Mulder’s Click Test.
- Rule out other obvious problems in the area like hammer toes or injuries.
- Sullivan’s sign = Splaying of the toes in the site of the neuroma.
- Xray and MRI to rule out other problems.
- Diagnosis is best performed by a podiatrist clinic.
- Podiatrist can take a detailed history, to see why you are having pain in the ball of the foot and nerve pain.
- Podiatrist or foot doctor can also then perform a detailed physical exam, to make sure nothing else is going on.
- An x-ray can also be performed in the office to rule out any bone problems.
- An ultrasound could also be performed to rule out any soft tissue injuries or capsule problems or muscle issues that can be causing nerve pain.
Differential Diagnosis of Morton’s Neuroma:
- Capsulitis – More of a sore and aching feeling in the joint of the toes.
- Metatarsalgia – Generalized pain in the ball of the foot.
- Hammer Toes – A crooked toe that presses against the shoe can cause nerve irritation that radiates.
- Swollen Painful Toe – The nerves in the toe can become irritated by this and radiate toward the foot.
- Foot Corn – A corn or callus can cause pain that radiates back toward the foot.
- Predislocation Syndrome – A loose and “clicking” second toe joint can mimic morton’s neuroma.
How to Perform a Mulder’s Click Test:
- Start the patient sitting or laying on their back on the examination table.
- Squeeze the base of the big toe and the base of the fifth toe with your hand, while squeezing the webspace of that foot with your other hand.
- If performed correctly there will be a clicking noise as the neuroma pops in and out of the tight space between the metatarsal heads.
- This can also create a numbness or shooting pain temporarily at the bottom of the foot in that area known as a paresthesia.
Jacob Mulder (1901-1965) Invented the Mulder’s Click Test:
- The Mulder’s Click Test is named after the Dutch Surgeon and Foot Doctor Jacob Mulder.
Other Tests to check for Morton Neuroma:
- Sullivan’s Sign.
- Xray to check for splaying.
Sullivan’s Sign Test:
- Sullivan’s sign is another test that can be used to check for Morton’s neuroma that can easily be performed. The podiatrist or foot doctor simply checks if there is widening of the effected toes. For example if the neuroma is suspected between the 3rd and the 4th toes, then they should angle out to the sides. The neuroma in between them should create a widening.
Morton’s Neuroma Can Still Happen If These Tests Are Negative:
Just because Sullivan’s sign or Mulders sign were not present does not mean that you don’t have a Morton’s Neuroma or neuroma pain. The best way to diagnose this disorder is still clinical results!
- Do you have numbness, burning or tingling?
- Do you ever hear a clicking sound?
- Do you ever feel like there is a pebble in your foot?
- Does it ever feel like your socks are bunched up?
- Does massaging your foot ever make it feel better?
Treatment of Morton’s Neuroma:
Ball of the Foot Pain Treatment Infographic:
Ball of the Foot Home Treatment:
- Consider taping, orthotics and great shoes as a combination to fix your foot problem.
- Products are not always necessary to fix your problem.
- The key is correcting the biomechanics that are leading to forefoot overload. Foot overload means too much pressure in the ball of the foot.
- Generally something called ankle joint equinus can lead to a too much pressure in the ball of your foot. This means your ankle is not flexible enough to move up and down.
- Ball of the foot pain treatment consists of two phases, first is control inflammation, next is to control bio-mechanics.
Remove Control Inflammation:
Massage & Ice Products:
- The metal ball is one of my personal favorites.
- This works great for your arch, less for the ball of the foot.
- These can help relax the arch or heel ligaments, leading to less pressure in the ball of the foot.
- Pills, creams and ice will never completely fix your problem alone. What they will do is reduce the pressure on the area.
Menthol Based Gels:
- Biofreeze is one of our favorites.
- These gels have been studied to work 2x as long as ice.
- This works great for the ball of the foot.
- Consider using these as options when resting on the couch or going to sleep at night.
- These can work great for loosening your muscles.
- This is means for your hamstring and calf muscles. This can loosen the ankle tightness putting pressure on the ball of your foot.
- This allows less tightness and pressure on the ball of your foot.
Ball of the Foot Stress Relief.
- The key is to prevent future pain.
- If you can get rid of the pain and swelling, this will let you start walking normally.
- If you can walk normally, the vast majority of your pain should gradually start to go away.
- This means proper cushion, proper stability and pressure relief from the front of your foot.
- This will relieve pressure from your big toe, your 2nd toe, your Morton’s neuroma, your plantar plate, hammer toes and joint capsules.
Best Metatarsalgia Shoes:
- Getting a great supportive pair of shoes will make sure that there is pressure removed from the ball of your foot.
- This is especially important if you have a metatarsalgia, a Morton’s neuroma, 2nd metatarsal overload syndrome and capsulitis!
- Consider shoes combined with a good supportive orthotic for best pain relief!
- The following link will show you what our favorites are.
Best Ball of the Foot Insoles:
- These are our recommended orthotics & insoles.
- There are different types for different shoes.
- Women’s shoes usually need a less bulky orthotic, but allow for less correction.
- A full length orthotic requires a running shoe, boot or comfortable walking/dress shoe.
Best Full Length Orthotics:
- Full length orthotics are the most recommended type for ball of the foot pain.
- Be aware that if they are too uncomfortable, it might be worth starting with a less corrective pair.
- Eventually you can then work your way up to these.
Best Dress Shoe Orthotics:
- These are a stronger option for shoes with tight dress shoes.
- Just be aware that less corrective orthotics & tight shoes are usually not a good combination.
Best 3/4 Length Orthotics:
- These may be a good option for ball of the foot if the full length orthotics are too tight or too uncomfortable.
Get A Great Dynamic Stretch:
- It is possible to stretch on your own, but these products can also really help!
- Personally I have the stationary block set up in my kitchen to stretch every day multiple times while getting my coffee!
- This will take pressure off of the ball of your foot.
Ball of the Foot Pain