A Mixed-Method Approach to Evaluating the Association Between Myofascial Trigger Points and Ankle/Foot Pain Using Handheld Sonography Equipment

Abstract

This mixed-method blinded research study used high-frequency diagnostic medical sonography (DMS) to document myofascial trigger points (MTrPs) associated with ankle/foot pain. A total of 17 symptomatic and 8 asymptomatic participants provided 500 MTrP areas for palpation. Forty-nine of these MTrP areas (including 16 tender points, 15 palpable MTrPs, and 18 palpated and imaged MTrPs) were compared with the patient’s ankle/foot pain, collected with the SF-12 Health Survey, Victorian Institute of Sports Assessment–Achilles questionnaire, and a visual analog scale. Qualitative analyses of the participants’ histories were used to understand the context of the data collected. The mean area of the 18 imaged MTrPs was 0.09 cm2, and they appeared inhomogeneous and hypoechoic. Those with right-sided MTrPs were statistically significant for those with reported pain. Participants with left-sided MTrPs did not demonstrate a significant correlation to reported pain. The results demonstrated a promising possible diagnostic approach using sonography to evaluate MTrPs in the ankle/foot for documenting myofascial pain. In addition, elastography and transducer frequencies >12 MHz are proposed as a DMS technique to increase overall diagnostic yield.