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.

Ankle/foot pain is one of the most common reasons people make an appointment to see their physician. 1 A recent systematic review demonstrated that as many as 20% of the population may have frequent ankle/foot pain, and each year over seven million Americans are hospitalized for problems related to the feet. 2 As a consequence, the economic burden of ankle/foot pain costs US insurance companies billions of dollars annually. 1 Evaluating patients with ankle/foot pain using sonography could help to select those patients in need of treatment as well as make appropriate use of health care resources. The ankle is the most injured joint in the body and a common source of musculoskeletal (MSK) pain. 3 Lateral ligament injury is the most common site of ankle injury seen in outpatient primary care. Posterior ankle pain is another common complaint. Sonography allows for the identification of common injuries or MSK disorders of the ankle, such as ligament sprains, tendon rupture, joint effusions, soft tissue masses, and peritendinous swelling. In addition, sonography provides a dynamic real-time evaluation of the ankle structures. 4 The focus of this research was to determine whether a hand-carried ultrasound (HCU) unit can assist in the screening evaluation of ankle/foot pain. Furthermore, an attempt to capture holistic, or whole individual, data combines tools not previously studied or regularly used together to assess individuals with ankle/foot pain. A review of the most recent guidelines from national and international organizations supports the use of MSK 631013J DMXXX10.

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