Re: Casting light on the overlooked trigger point of the interosseous muscles in metatarsalgia: insights and treatment strategies

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Ultrasonography. 2024;43(4):297-298
Publication date (electronic) : 2024 June 3
doi :
1Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Jee Won Chai, MD, Department of Radiology, SMG-SNU Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjakgu, Seoul 07061, Korea Tel. +82-2-870-2549 Fax. +82-2-870-3531 E-mail:
Received 2024 May 30; Revised 2024 June 3; Accepted 2024 June 3.

We read the letter to the editor by Dr. Alyanak et al. [1] with great interest and would like to express our gratitude for highlighting this valuable topic for discussion.

Myofascial pain syndrome (MPS) is a prevalent cause of musculoskeletal pain, accounting for up to 30% of musculoskeletal complaints in primary care settings [2,3]. MPS is identified by the presence of one or more myofascial trigger points. Typically, the diagnosis of MPS is established through a physical examination, which involves palpating the hard nodule (myofascial trigger point) that triggers pain and disability within the taut bands of skeletal muscles [3,4]. Histologically, the so-called "trigger point complex" consists of normal or abnormal muscle fibers with focal enlargements (contraction knots) and mechanical disorganization of the extracellular matrix. These changes can be observed as macroscopic alterations in texture via ultrasonography [4]. The trapezius muscle is the most frequently affected and studied area for using ultrasonography to visualize myofascial trigger points [4-6]. Ultrasonographic studies characterize myofascial trigger points as localized hypoechoic regions within the muscle, which may exhibit changes in blood flow and increased stiffness in sonoelastographic studies [4-6].

However, as Dr. Alyanak et al. [1] stated, the literature on the use of ultrasonography for diagnosing MPS is quite limited and requires further investigation [6]. To date, there are no documented cases of ultrasonography being used to diagnose MPS in the interossei muscles or any other areas of the foot. The identification of myofascial trigger points within the interossei muscles can be particularly challenging due to their small size and oblique orientation. Our review article primarily addressed the ultrasonographic differential diagnosis of metatarsalgia [7], and therefore, discussions of MPS and associated interventional procedures were not included within its scope. However, we appreciate Dr. Alyanak et al. for providing the opportunity to offer additional insights on MPS, which is also a potential contributor to metatarsalgia.


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


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