Department of Surgery-Human Structural Topography-School of Medicine, University of São Paulo, São Paulo 01246-903, Brazil.
Biomed Res Int. 2020 Jan 22;2020:9240581. doi: 10.1155/2020/9240581. eCollection 2020.
Myofascial pain syndrome is characterized by pain and a limited range of joint motion caused by muscle contracture related to motor-end-plate dysfunction and the presence of myofascial trigger points (MTrPs). It is the most frequent cause of musculoskeletal pain, with a worldwide prevalence varying between 13.7% and 47%. Of the patients with myofascial pain syndrome, approximately 17% have pain in the medial hindfoot area. The abductor hallucis muscle is located in the medial, posterior region of the foot and is related to painful plantar syndromes. The objective of this study was to describe the distribution of the medial plantar nerve and their anatomical relationship with MTrPs found in the literature. Thirty abductor hallucis muscles were dissected from 15 human cadavers (8 males and 7 females). The muscles were measured, and the distribution data of the medial plantar nerve branches in each quadrant were recorded. For statistical analysis, we used generalized estimation equations with a Poisson distribution and a log logarithm function followed by Bonferroni multiple comparisons of the means. The data are expressed as the mean ± standard deviation. The level of significance was adjusted to 5% ( < 0.05). A high concentration of nerve branches was observed in the first quadrant (Q1) of the abductor hallucis muscle, which is the same area in which the MTrPs are described. The topography of the entry points of the branches of the medial plantar nerve to the abductor hallucis muscle correlates with the topography of the muscular trigger points. The anatomical structure of the MTrPs may be useful for a better understanding of the pathophysiology of myofascial disorders and provide a basis for surgical and clinical treatments.
肌筋膜疼痛综合征的特征是疼痛和关节运动范围受限，这是由于与运动终板功能障碍和肌筋膜触发点（MTrPs）相关的肌肉挛缩引起的。它是肌肉骨骼疼痛最常见的原因，全球患病率在 13.7%至 47%之间。肌筋膜疼痛综合征患者中，约有 17%的患者出现内侧足跟区域疼痛。拇展肌位于足部的内侧和后部，与疼痛性足底综合征有关。本研究的目的是描述内侧足底神经的分布及其与文献中发现的 MTrPs 的解剖关系。从 15 具人体尸体（8 名男性和 7 名女性）中解剖了 30 块拇展肌。测量了肌肉，并记录了内侧足底神经分支在每个象限的分布数据。为了进行统计分析，我们使用了广义估计方程，其分布为泊松分布，对数函数，然后是 Bonferroni 多重比较均值。数据表示为平均值±标准差。显著性水平调整为 5%（<0.05）。在拇展肌的第一象限（Q1）观察到神经分支的高浓度，这与 MTrPs 所在的区域相同。内侧足底神经分支进入拇展肌的入口点的分布与肌肉触发点的分布相对应。MTrPs 的解剖结构可能有助于更好地理解肌筋膜疾病的病理生理学，并为手术和临床治疗提供基础。
