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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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Mycoside3