Muscle Trigger Points and Pressure Pain Sensitivity Maps of the Feet in Women with Fibromyalgia Syndrome

Abstract

OBJECTIVE : To investigate the presence of trigger points (TrPs) in feet musculature and topographical pressure sensitivity maps of the feet as well as the relationship between TrPs, pressure pain maps, and clinical variables in women with fibromyalgia (FMS). METHODS : Fifty-one FMS women and 24 comparable healthy women participated. TrPs within the flexor hallucis brevis, adductor hallucis, dorsal interossei, extensor digitorum brevis, and quadratus plantae, as well as external and internal gastrocnemius, were explored. Pressure pain thresholds (PPTs) were assessed in a blind manner over seven locations on each foot. Topographical pressure sensitivity maps of the plantar region were generated using the averaged PPT of each location. RESULTS : The prevalence rate of foot pain was 63% (n = 32). The number of active TrPs for each FMS woman with foot pain was 5 ± 1.5 without any latent TrPs. Women with FMS without foot pain and healthy controls had only latent TrPs (2.2 ± 0.8 and 1.5 ± 1.3, respectively). Active TrPs in the flexor hallucis brevis and adductor hallucis muscles were the most prevalent. Topographical pressure pain sensitivity maps revealed that FMS women with foot pain had lower PPT than FMS women without pain and healthy controls, and higher PPT on the calcaneus bone (P < 0.001). CONCLUSIONS : The presence of foot pain in women with FMS is high. The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in these patients. FMS women suffering foot pain showed higher pressure hypersensitivity in the plantar region than those FMS women without pain.

Quality of life related to foot health status in women with fibromyalgia: a case-control study

“…Future interventional studies, i.e. generic treatments such as pregabalin [35] or specific interventions such as foot trigger points dry needling [36, 37] and custom-made foot orthotics [38] in women with fibromyalgia, could use these clinical differences as key references in order to normalize the specific foot and general health-related quality of life. In line with prior research [8], we highlight that health authorities should pay more attention to improving the general and foot specific health-related quality of life in women with fibromyalgia.…”

Spotlight on topographical pressure pain sensitivity maps: a review

“…Concerning the lower extremities, topographical pressure pain sensitivity maps of the foot, 28 the knee, 29 and the entire lower limb 30 have been generated. For the foot, seven anatomical locations including the first, third, and fifth metatarsal bones, the belly of the abductor digiti minimi muscle, the belly of the flexor digitorum brevis muscle, the belly of the abductor hallucis muscle, and the calcaneus bone were used to form the PPT maps of the plantar region of the foot ( Figure 6 ).…”

“…For the foot, seven anatomical locations including the first, third, and fifth metatarsal bones, the belly of the abductor digiti minimi muscle, the belly of the flexor digitorum brevis muscle, the belly of the abductor hallucis muscle, and the calcaneus bone were used to form the PPT maps of the plantar region of the foot ( Figure 6 ). 28 For the knee, eight points over the peri-patellar region related to anatomical bony landmarks were used: 29 1) 2 cm distal to the inferior medial edge of patella, 2) 2 cm distal to the inferior lateral edge of patella, 3) 3 cm lateral to the mid-point on the lateral edge of patella, 4) 2 cm proximal to the superior lateral edge of patella, 5) 2 cm proximal to the superior edge of patella, 6) 2 cm proximal to the superior medial edge of patella; 7) 3 cm medial to the mid-point on the medial edge of patella; and 8) the center of patella ( Figure 7 ).…”

“…Topographical pressure pain sensitivity maps have also been applied to investigate spatial changes in sensitivity to pressure; not just within the same muscle, but also in a particular anatomical area including the scalp, 37 , 38 shoulder, 19 , 23 elbow, 26 hand, 25 low back, 21 knee, 29 foot, 28 and the entire lower extremity. 30 These studies included different pain populations such as nummular headache, 37 migraine, 38 breast cancer survivors, 19 subacromial pain syndrome, 23 lateral elbow pain, 26 carpal tunnel syndrome, 25 knee osteoarthritis, 29 fibromyalgia syndrome, 28 and in asymptomatic adults 21 or soccer players. 30 …”

Topographic mapping of pain sensitivity of the lower back – a comparison of healthy controls and patients with chronic non-specific low back pain

“…The test site is one of the variables that need careful consideration when assessing pain sensitivity and a number of studies have examined the spatial distributions of pain sensitivity in the neck/shoulder region [15][16][17][18][19], the head and scalp [20][21][22], the upper extremities [23,24], the lower extremities [25][26][27], and lower back [17]. Most studies have used mechanical pressure pain thresholds and some thermal stimuli [23,24].…”