Hi Mr. Spock! Vulcan salute detects painful foot neuroma

“The Vulcan salute on conventional x-rays is specific to Morton’s neuroma,” wrote radiologist Dr Julien Galley of the University of Zurich, Switzerland, and colleagues.

Morton’s neuroma was first described by Thomas Morton in the mid-1800s. It is a painful condition that affects the soles of the feet, most commonly the area between the third and fourth toes. The condition occurs when the nerve between the bones of the toes becomes inflamed. Women are about eight to ten times more likely than men to develop the disease, possibly from shoe styles, the authors wrote.

Morton’s neuroma can cause toe divergence, which resembles vulcan x-ray salute, according to the authors.

(A) Negative Vulcan hello sign in a 50-year-old woman in the control group (A). (B) Positive vulcan salute sign (V sign) of the mid-space 3/4 in a 46-year-old woman with Morton’s neuroma. (C) “Hi Vulcan” from one of the authors. Image courtesy of Skeletal radiology.

For those unfamiliar with the “Star Trek” TV series and the character of Mr. Spock, the Vulcan salute (abbreviated as “V-sign” in the article) is a hand gesture made by separating the middle and middle fingers. finger while the palm is facing forward and the thumb is extended.

In this retrospective case-control study, Galley and colleagues recruited 100 patients with 2/3 or 3/4 MRI-proven Morton’s neuroma (between the second and third or third and fourth toe) and 100 unconditional patients. Conventional dorsoplantar loaded radiographs were evaluated for the subjective presence of the V sign by two independent, blind musculoskeletal radiologists.

Conventional x-rays of the foot were taken from the standard supported dorsoplantar view, with the central ray directed towards the middle of the third metatarsal. The x-ray tube was tilted cranially at 15 °.

The researchers found a significant difference between the groups in the presence of the V sign, which was found in 30 of 100 patients in the Morton’s neuroma group and in three of 100 control patients, with a sensitivity of 30% and a specificity of 97. %.

Differences between interphalangeal angles were also significant between groups, with 2/3 and 3/4 higher interphalangeal angle values ​​for the study group than for the control group. Interobserver agreement was important for the V sign, with a kappa value of 0.78.

While there was no discussion within the group regarding who is the biggest “Trekkie” (“Star Trek” fan), the researchers noted that the V sign on the x-rays may not rule out. not be Morton’s neuroma, given its low sensitivity. In addition, all the patients included in the study underwent an MRI for clinical indications and the exclusion criteria were broad, which could suggest a selection bias.

Nonetheless, conventional radiography is recommended as the first radiologic procedure by the American College of Radiology Appropriateness Criteria for the assessment of chronic foot pain, and in cases of Morton’s neuroma, x-rays may be helpful, the authors wrote. authors.

“The presence of a V sign on a standard x-ray is very suggestive of the presence of Morton’s neuroma,” concluded Galley et al.

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