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02/22/2014 David Secord, DPM, Kyle Scholnick, DPM
Valleix’s Sign (Tarsal Tunnel Syndrome, Jan 2014 PM)
On page 123 of the January 2014 Podiatry Management Magazine, Dr. Scholnick refers to “A positive Tinel’s or Valleix’s sign is when paraesthesias course along the involved nerve distally or proximately, respectively.” This is my favorite 'medical urban legend' and has been my personal quest to expunge from our schools and usage.
As opposed to what many of us were taught in medical school, Tinel's sign is both proximal and distal tingling upon percussion of a nerve. Valleix’s sign does not exist. There is no such thing. Valleix’s POINTS are as follows: 1. Where the nerve emerges from the bony canal. 2. Where it pierces a muscle or aponeurosis to reach the skin. 3. Where a superficial nerve rests upon a resisting surface. 4. Where the nerve gives of one or more branches or bifurcations. 5. Where the nerve terminates in the skin.
I hope this helps clarify this, but hold out little hope that it will kill off the notion of a 'Valleix’s sign', although it would be nice. David Secord, DPM References: Valleix FLI. Traite des nervalgies ou affections douloureuses des nerfs. J. B. Bailliere, Paris, 1841 (pp. 266-594).
David Secord, DPM, Corpus Christi, TX, LEDocDave@hotmail.com
Response: The number of references that define Valleix sign as a proximal radiation of pain and paresthesia along the neuraxis on percussion of a nerve are immense. Two quick examples would be:
McGlamry's 4th edition in Chapter 66: General Entrapment Syndromes, page 912.
Nerve Entrapment Syndromes of the Lower Extremity by Dr. Minoo Hadjari Hollis, MD: http://emedicine.medscape.com/article/1234809- overview#aw2aab6b5
I was using the terminology that is in common usage in our profession. I do sincerely appreciate Dr. Secord's productive input.
The quote being referred to is actually located on page 124 of the January 2014 Podiatry Management Magazine edition in case anyone was looking for it, not page 123 as Dr. Secord referenced.
Kyle Scholnick, DPM, New Haven, CT, kyle.scholnick@yale.edu
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