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The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs

OBJECTIVES: To assess the value of the divergence of toes on conventional radiographs of the foot for diagnosing Morton’s neuroma. METHODS: This retrospective case–control study was approved by the local ethics committee. In 100 patients with MRI-proven Morton’s neuroma 2/3 or 3/4 (study group) and...

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Autores principales: Galley, Julien, Sutter, Reto, Germann, Christoph, Pfirrmann, Christian W. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763827/
https://www.ncbi.nlm.nih.gov/pubmed/34263343
http://dx.doi.org/10.1007/s00256-021-03851-3
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author Galley, Julien
Sutter, Reto
Germann, Christoph
Pfirrmann, Christian W. A.
author_facet Galley, Julien
Sutter, Reto
Germann, Christoph
Pfirrmann, Christian W. A.
author_sort Galley, Julien
collection PubMed
description OBJECTIVES: To assess the value of the divergence of toes on conventional radiographs of the foot for diagnosing Morton’s neuroma. METHODS: This retrospective case–control study was approved by the local ethics committee. In 100 patients with MRI-proven Morton’s neuroma 2/3 or 3/4 (study group) and 100 patients without (control group), conventional weight-bearing dorso-plantar view radiographs were evaluated for the subjective presence of interphalangeal divergence, called the Vulcan salute sign or V-sign, by two blinded, independent musculoskeletal radiologists. Interphalangeal angles (2/3 and 3/4) and intermetatarsal angle I/V were measured. The t test and chi-squared test were used to compare the groups. Diagnostic performance was calculated. Interobserver reliability was assessed using κ statistics and intraclass correlation coefficient (ICC). RESULTS: The difference between the groups was significant (P < 0.05) regarding the presence of the V-sign, which was found in 30 of 100 patients with Morton neuroma and in 3 of 100 control patients, with a sensitivity of 30% and a specificity of 97%. The differences between interphalangeal angles were significant (P < 0.05) between the groups. The interphalangeal angle 2/3 mean values were 7.9° (± 4.8) for the study group vs 5.4° (± 2.6) for the controls; the 3/4 angle values were 6.5° (± 3.8) and 3.4° (± 2.5), respectively. There was no significant difference between the groups in the intermetatarsal angle I/V. Interobserver agreement was substantial for the V-sign, with a κ value of 0.78. The ICC was excellent concerning angle measurements, with all values ≥ 0.94. CONCLUSION: The Vulcan salute sign on conventional radiographs is specific for Morton’s neuroma.
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spelling pubmed-87638272022-01-31 The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs Galley, Julien Sutter, Reto Germann, Christoph Pfirrmann, Christian W. A. Skeletal Radiol Scientific Article OBJECTIVES: To assess the value of the divergence of toes on conventional radiographs of the foot for diagnosing Morton’s neuroma. METHODS: This retrospective case–control study was approved by the local ethics committee. In 100 patients with MRI-proven Morton’s neuroma 2/3 or 3/4 (study group) and 100 patients without (control group), conventional weight-bearing dorso-plantar view radiographs were evaluated for the subjective presence of interphalangeal divergence, called the Vulcan salute sign or V-sign, by two blinded, independent musculoskeletal radiologists. Interphalangeal angles (2/3 and 3/4) and intermetatarsal angle I/V were measured. The t test and chi-squared test were used to compare the groups. Diagnostic performance was calculated. Interobserver reliability was assessed using κ statistics and intraclass correlation coefficient (ICC). RESULTS: The difference between the groups was significant (P < 0.05) regarding the presence of the V-sign, which was found in 30 of 100 patients with Morton neuroma and in 3 of 100 control patients, with a sensitivity of 30% and a specificity of 97%. The differences between interphalangeal angles were significant (P < 0.05) between the groups. The interphalangeal angle 2/3 mean values were 7.9° (± 4.8) for the study group vs 5.4° (± 2.6) for the controls; the 3/4 angle values were 6.5° (± 3.8) and 3.4° (± 2.5), respectively. There was no significant difference between the groups in the intermetatarsal angle I/V. Interobserver agreement was substantial for the V-sign, with a κ value of 0.78. The ICC was excellent concerning angle measurements, with all values ≥ 0.94. CONCLUSION: The Vulcan salute sign on conventional radiographs is specific for Morton’s neuroma. Springer Berlin Heidelberg 2021-07-14 2022 /pmc/articles/PMC8763827/ /pubmed/34263343 http://dx.doi.org/10.1007/s00256-021-03851-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Scientific Article
Galley, Julien
Sutter, Reto
Germann, Christoph
Pfirrmann, Christian W. A.
The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs
title The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs
title_full The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs
title_fullStr The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs
title_full_unstemmed The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs
title_short The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs
title_sort vulcan salute sign: a non-sensitive but specific sign for morton’s neuroma on radiographs
topic Scientific Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8763827/
https://www.ncbi.nlm.nih.gov/pubmed/34263343
http://dx.doi.org/10.1007/s00256-021-03851-3
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