Active Muscle Trigger Points Are Associated with Pain and Related Disability in Patients with Plantar Heel Pain: A Case–Control Study

Abstract

Objective Pain experienced by patients with plantar heel pain has been associated with fascia thickness. It is possible that referred muscle pain may also be related to symptoms experienced by these patients. Our aim was to systematically investigate if the referred pain elicited by trigger points in the leg and foot musculature reproduces the symptoms in individuals with plantar heel pain and to determine the association of trigger points (TrPs) with pain and related disability. Methods A case–control study was conducted. Thirty-five individuals with unilateral chronic plantar heel pain and 35 matched comparable healthy controls participated. An assessor blinded to the subject’s condition explored TrPs in the flexor hallucis brevis, adductor hallucis, quadratus plantae, and internal gastrocnemius. Pain and related disability were assessed with a numerical pain rating scale (0–10), the Foot Function Index, and the Foot Health Status Questionnaire. Results The number of TrPs for each patient with plantar heel pain was 4 ± 3 (2.5 ± 2 active TrPs, 1.5 ± 1.8 latent TrPs). Healthy controls only had latent TrPs (mean = 1 ± 1). Active TrPs in the quadratus plantae (N = 20, 62.5%), and flexor hallucis brevis (N = 19, 59%) were the most prevalent in patients with plantar heel pain. A greater number of active, but not latent, TrPs was associated with higher foot pain variables (0.413 < rs < 0.561, P < 0.01), higher impact of foot pain (0.350 < rs < 0.473, P < 0.05) and worse related disability (–0.447 < rs < –0.35456, P < 0.05). Conclusions The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in patients with plantar heel pain. A greater number of active TrPs was associated with higher pain and related disability in patients with plantar heel pain.

Effectiveness of Massage Including Proximal Trigger Point Release for Plantar Fasciitis: a Case Report

“…(2) Connections between trigger points (TrPs) and PF symptoms have been found. (3,9,10) TrPs are hyperirritable points in muscles or fascia that are tender on palpation, produce distal referred pain, and autonomic responses. (9,1) Primarily formed f rom overuse, TrPs are categorized as active or latent.…”

“…(3,9,10) TrPs are hyperirritable points in muscles or fascia that are tender on palpation, produce distal referred pain, and autonomic responses. (9,1) Primarily formed f rom overuse, TrPs are categorized as active or latent. (11) Active TrPs are responsible for causing local and referred pain, replicating symptoms of a patient.…”

“…(11) Active TrPs are responsible for causing local and referred pain, replicating symptoms of a patient. (9,11,12) Latent TrPs do not cause pain unless mechanically stimulated or activated. (9,11) Both active and latent TrPs cause stiffness after inactivity, decreased range of motion (ROM), and weakness of associated muscles.…”

Ultrasound-guided Dry Needling in Jumper’s Knee: A Case Report

“…Besides, similarly to another pathologies [11], patient was examined for the presence of active myofascial trigger points (MTrPs). MTrPs diagnosis was conducted following the updated criteria described by Simons and recommended in a recent Delphi study [12]: 1) presence of a palpable taut band in skeletal muscle, 2) presence of a painful spot in the taut band, and 3) presence of referred pain in response to manual compression.…”

“…MTrPs diagnosis was conducted following the updated criteria described by Simons and recommended in a recent Delphi study [12]: 1) presence of a palpable taut band in skeletal muscle, 2) presence of a painful spot in the taut band, and 3) presence of referred pain in response to manual compression. These criteria, when applied by a trained assessor, showed good interexaminer reliability (kappa), ranging from 0.64 to 0.88 [11,13]. MTrPs were explored in adductor longus, adductor brevis, rectus femoris and vastus medialis muscles.…”