Imaging Biomarker for Identifying Myofascial Pain in Individuals with Heel Pain: A Cross-Sectional Study

Zahra Amerian; Timothy Fleagle; Utsav Tuladhar; Rachel Watson; Micah Wong; Barbara VanGorp; Brian Smith; Michael Richards; Maderic Hall; Joe Donnelly; Jessica Danielson; Renata Vidal Leao; David Stanley; Vincent Magnotta; James H Holmes; Kathleen Sluka; Ruth L Chimenti

doi:10.1016/j.jpain.2025.105945

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Imaging Biomarker for Identifying Myofascial Pain in Individuals with Heel Pain: A Cross-Sectional Study

Abstract

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Imaging Biomarker for Identifying Myofascial Pain in Individuals with Heel Pain: A Cross-Sectional Study

Zahra Amerian, Timothy Fleagle, Utsav Tuladhar, Rachel Watson, Micah Wong, Barbara VanGorp, Brian Smith, Michael Richards, Maderic Hall, Joe Donnelly, …

The journal of pain, Vol.41(Supplement), 105945

03/2026

DOI: 10.1016/j.jpain.2025.105945

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Abstract

Myofascial pain is an underdiagnosed contributor to musculoskeletal conditions, including heel pain. It is characterized by trigger points in muscles that can reproduce an individual’s pain. Current diagnosis relies on manual palpation, which lacks objective precision, highlighting the need for validated biomarkers. This study aims to develop a diagnostic imaging biomarker using ultrasound (US) shear wave elastography to detect abnormal myofascial tissue in individuals with heel pain, including plantar heel pain and insertional Achilles tendinopathy. Preliminary data were collected from 10 participants (mean age: 46 ± 11.07 years; BMI: 34.69 ± 9.65 kg/m²; 80% female), including 8 with plantar heel pain and 2 with insertional Achilles tendinopathy. Participants underwent clinical examination of five calf and foot muscles to identify trigger points. Based on Travell and Simons’ criteria, trigger points were categorized as “active” if applied pressure reproduced the participant’s pain or elicited referred pain. Blinded US shear wave elastography was performed, followed by pressure pain threshold (PPT) measurements. Paired t-tests compared shear wave speed of muscles with and without active trigger points. Among the 8/10 participants with active trigger points, shear wave speed was significantly higher at sites with active trigger points (3.31 ± 0.98 m/s) compared to sites without (2.42 ± 0.20 m/s; p = 0.029). PPT did not differ significantly between sites with (433.10 ± 190.79 kPa) and without (440.95 ± 185.52 kPa) active trigger points (p = 0.848). These findings support US imaging as a potential diagnostic biomarker for the myofascial component of heel pain. Funding: R61AT012275.

Details

Title: Subtitle: Imaging Biomarker for Identifying Myofascial Pain in Individuals with Heel Pain: A Cross-Sectional Study
Creators: Zahra Amerian
Timothy Fleagle
Utsav Tuladhar
Rachel Watson
Micah Wong
Barbara VanGorp
Brian Smith
Michael Richards
Maderic Hall
Joe Donnelly
Jessica Danielson
Renata Vidal Leao
David Stanley
Vincent Magnotta
James H Holmes
Kathleen Sluka
Ruth L Chimenti
Resource Type: Abstract
Publication Details: The journal of pain, Vol.41(Supplement), 105945
DOI: 10.1016/j.jpain.2025.105945
ISSN: 1526-5900
eISSN: 1528-8447
Publisher: Elsevier
Grant note: Funding: R61AT012275.
Language: English
Date published: 03/2026
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Electrical and Computer Engineering; Psychiatry; Iowa Neuroscience Institute; Nursing; Physical Therapy and Rehabilitation Science; Neuroscience and Pharmacology
Record Identifier: 9985149524602771

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