Mulder's Test: how to detect Morton's neuroma

If a client describes forefoot pain as "feeling like a pebble in my shoe" or an electric shock between the toes, especially between the third and fourth toes, there's a usual suspect: Morton's neuroma. Mulder's test is the classic maneuver to check for it.

What does this test measure?

It checks for the presence of an interdigital neuroma (a thickening of tissue around a plantar nerve, typically between the 3rd and 4th metatarsals) by compressing the forefoot, which can produce a palpable and/or painful "click" as the neuroma shifts between the metatarsal heads.

Equipment needed

• None required

Step-by-step protocol

1. Have the person sit or lie down with the foot relaxed
2. With one hand, squeeze the forefoot transversely (from side to side, bringing the metatarsal heads together), simulating the compression of a tight shoe
3. With the fingers of your other hand, press on the suspected interdigital space (usually between the 3rd and 4th toes) from the sole toward the top of the foot
4. Hold both pressures at the same time and check whether you observe:

- A palpable "click" - Pain localized or radiating into the adjacent toes

Common mistakes

• Applying transverse compression without simultaneous plantar pressure (this reduces the test's sensitivity)
• Confusing pain from general mechanical metatarsalgia (no "click") with a neuroma
• Not checking all interdigital spaces when the location of the pain isn't clear

How to interpret the result

Result	Interpretation
Negative	No click or pain reproduced with combined compression — Morton's neuroma less likely
Positive	Palpable click and/or reproduced pain in the interdigital space — suggests Morton's neuroma

A positive Mulder's test, combined with the typical clinical picture (pain between the toes that improves when shoes come off or with massage), usually warrants referral for ultrasound confirmation, which can also measure the size of the neuroma and guide treatment.

Related tests

Forefoot pain can have several causes worth differentiating:

• Windlass test (plantar fascia) — to rule out a fascial rather than neural origin
• Tinel's test at the foot/ankle — if there's suspicion of a more proximal nerve issue (tarsal tunnel) in addition to the distal neuroma

Track and monitor

Pain from Morton's neuroma is often heavily influenced by footwear (especially narrow shoes or high heels) and by training impact volume. With Movalytics you can log the Mulder's test result and pain intensity at each assessment, making it easy to connect symptom changes with shifts in footwear, surface, or training load.

Frequently asked questions

Is Morton's neuroma the same as plantar fasciitis? No. Fasciitis affects the plantar fascia and typically hurts more in the heel/arch, while Morton's neuroma involves an interdigital nerve and typically causes pain between the toes of the forefoot. Can changing shoes help? Yes, shoes with a wide toe box and no heel usually reduce compression on the affected interdigital space and ease symptoms in mild cases. Does a negative Mulder's test rule out Morton's neuroma? Not definitively. Its sensitivity is limited, so if the clinical picture is still suggestive, imaging should be considered.