Anatomical Localization of Motor Points of the Abductor Hallucis Muscle: A Cadaveric Study

Additional effect of neuromuscular electrical stimulation in a conservative intervention on morphology and strength of abductor hallucis muscle and correction of hallux valgus deformity: a randomized controlled trial

BACKGROUND

In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle.

OBJECTIVES

This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability.

METHODS

Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis.

RESULTS

The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p < .001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤ .05). Pain decreased significantly in the two groups (p < .001 and p = .02). Intermetatarsal angle did not significantly differ between the two groups (p = .86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p = .007, partial eta effect size = 0.15).

CONCLUSION

Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus.

TRIAL REGISTRATION NUMBER

The RCT Code is IRCT20200915048725N1.

Nerve entry points - The anatomy beneath trigger points

INTRODUCTION

Myofascial trigger points (MTrPs) have been the subject of considerable scientific research for almost forty years. In their seminal paper, Travell and Simons described a model based on the presence of highly irritable, palpable nodules within taut bands of muscle. Since then, a significant number of studies have increased our understanding of the phenomenon, which has, in turn, resulted in refutation of the original model. Alternative models have explained certain properties of MTrP but fail to provide an explanation of their spatial distribution. The aim of this paper was to propose a hypothesis connecting MTrPs and distinct points along the course of the nerve called nerve entry points (NEPs). A literature review was performed in order to identify studies to support hypothesis development.

METHODS

Literature search of digital databases.

RESULTS

A total of 4631 abstracts were screened; 72 were selected for further review. Four articles made a direct connection between MTrPs and NEPs. Another fifteen articles provided high-quality data regarding the distribution of NEPs, thus strengthening the hypothesis.

CONCLUSIONS

There is sufficient evidence to hypothesise that NEPs are the anatomical basis for MTrPs. This presented hypothesis addresses one of the crucial issues in diagnosing trigger points, which is the lack of repeatable and reliable diagnostic criteria. By connecting subjective phenomenon of trigger points with objective anatomy, this paper provides a novel and practical foundation for identifying and treating pain conditions associated with MTrPs.

Distinct Neuroanatomical Structures of Acupoints Kidney 1 to Kidney 8: A Cadaveric Study

Objective: The Systematic Classic/Zhen Jiu Jia Yi Jing (ZJJYJ, ) is considered to be the first complete acupuncture manual to detail the location and meridian assignations of 349 acupuncture points. Despite numerous transcriptions and editing changes, many traditional acupuncturists adhere to the classics and rarely question their validity. However, ushering the use of acupuncture into the modern era requires examining acupuncture point locations objectively by comparing contemporary anatomical knowledge with classical texts. The aim of this research was to examine distinct neuroanatomical targets associated with acupuncture points to: (1) standardize the precise neuroanatomical target of each acupuncture point; and (2) crossreference neuroanatomical targets with classical point locations. This was done to demonstrate ancient authors' intentions when describing acupuncture points as coordinates used to stimulate the peripheral nervous system. Materials and Methods: The unique neuroanatomical targets associated with acupuncture points on the Foot Shao Yin Kidney meridian were defined. Specifically, KI 1 through KI 8 were examined by comparing classical point locations from the ZJJYJ with modern standardized textbook locations from Chinese Acupuncture and Moxibustion, current anatomical literature, the current authors' cadaver dissection research, and electrostimulation of acupuncture points in healthy volunteers. Results: KI 1-KI 8 correlated with motor entry points as well as with nerve branches and vessels derived from the posterior tibial neurovascular bundle. Conclusions: This research demonstrated a procedure to verify and standardize the distinct neuroanatomical structures of acupuncture points. Standardization of neuroanatomical targets of acupuncture points will enable researchers and clinicians to obtain reproducible results in clinical treatments and research protocols.