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Ultrasonography
Ultrasonography
USG
Ultrasonography
2288-5919
2288-5943
Korean Society of Ultrasound in Medicine

39169822
10.14366/usg.24115
usg-24115
Letter
Re: Re: Casting light on the overlooked trigger point of the interosseous muscles in metatarsalgia: insights and treatment strategies
http://orcid.org/0000-0003-4295-4286
Alyanak Bülent 1
http://orcid.org/0000-0002-0127-8958
Dede Burak Tayyip 2
http://orcid.org/0000-0003-0256-5833
Temel Mustafa Hüseyin 3
http://orcid.org/0000-0002-9697-6184
Yıldızgören Mustafa Turgut 4
http://orcid.org/0000-0002-6103-7873
Bağcıer Fatih 5
1 Gölcük Necati Çelik State Hospital, Physical Medicine and Rehabilitation Clinic, Kocaeli, Turkey
2 Prof. Dr. Cemil Tascioglu City Hospital, Physical Medicine and Rehabilitation Clinic, İstanbul, Turkey
3 üsküdar State Hospital, Physical Medicine and Rehabilitation Clinic, İstanbul, Turkey
4 Konya City Hospital, Physical Medicine and Rehabilitation Clinic, Konya, Turkey
5 Basaksehir Cam Sakura City Hospital, Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey
Correspondence to: Bülent Alyanak, MD, Gölcük Necati Çelik State Hospital, Physical Medicine and Rehabilitation Clinic, Çiftlik, Gölcük Devlet Hst., 41650 Gölcük/ Kocaeli, Türkiye Tel, Fax. +90-2624357660 E-mail: bulentalyanak@hotmail.com
9 2024
1 8 2024
43 5 393394
20 6 2024
1 8 2024
Copyright © 2024 Korean Society of Ultrasound in Medicine (KSUM)
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmcWe would like to thank Dr. Chai et al. [1] for their detailed response and interest. We have carefully reviewed their response and appreciate the opportunity to discuss this issue further. Below, we offer our thoughts on the points raised in their response:

Although the literature on the use of ultrasonography (US) for diagnosing myofascial pain syndrome (MPS) is somewhat limited, there has been a notable increase in research on this topic in recent years. MPS is a prevalent condition, with estimates suggesting that among patients with chronic musculoskeletal pain, the prevalence of MPS can range from 85% to 95% [2]. Despite its commonality, MPS is frequently overlooked by clinicians. Moreover, physical examinations have been reported as unreliable in diagnosing MPS [3].

US imaging techniques, including grayscale, Doppler, and elastographic US, have shown promise in accurately localizing myofascial trigger points (MTrPs) with varying degrees of diagnostic accuracy, reporting sensitivity rates between 33% and 91% and specificity rates from 75% to 100% [4]. Typically, a myofascial trigger point appears on US imaging as a hypoechoic nodule with well-defined borders and a heterogeneous internal echotexture. Vibratory sonoelastography typically displays these nodules as hard, while Doppler imaging reveals altered blood flow patterns around MTrPs, with active MTrPs exhibiting high-resistance and retrograde diastolic flow [5]. Additionally, US guidance improves the detection of local twitch responses in deep muscles, which are frequently overlooked by visual inspection alone [6]. The local twitch response is a recognized diagnostic criterion for MPS. Observing this response aids in confirming the MPS diagnosis. To date, there have been no cases where US has been employed to diagnose MPS in the interossei muscles or other parts of the foot. However, given the existing literature, we believe such applications are feasible. We consider our correspondence to be of significant value as it may inspire further research in this area.

We believe that our exchange of views on these issues has the potential to encourage further research. Thank you again for your response and interest. If you would like to discuss the topic further or provide additional information, we would be happy to respond.

No potential conflict of interest relevant to this article was reported.
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References

1 Chai JW Kim DH Kim HJ Seo J Re: Casting light on the overlooked trigger point of the interosseous muscles in metatarsalgia: insights and treatment strategies Ultrasonography 2024 43 297 298 38886890
2 Mazza DF Boutin RD Chaudhari AJ Assessment of myofascial trigger points via imaging: a systematic review Am J Phys Med Rehabil 2021 100 1003 1014 33990485
3 Sikdar S Shah JP Gebreab T Yen RH Gilliams E Danoff J Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue Arch Phys Med Rehabil 2009 90 1829 1838 19887205
4 Elbarbary M Sgro A Goldberg M Tenenbaum H Azarpazhooh A Diagnostic applications of ultrasonography in myofascial trigger points: a scoping review and critical appraisal of literature J Diagn Med Sonogr 2022 38 559 573
5 Kumbhare DA Elzibak AH Noseworthy MD Assessment of myofascial trigger points using ultrasound Am J Phys Med Rehabil 2016 95 72 80 26334421
6 Rha DW Shin JC Kim YK Jung JH Kim YU Lee SC Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography Arch Phys Med Rehabil 2011 92 1576 1580 21839982
