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Ankle Sprain


Myofascial trigger points (tiny contraction knots) in overused or poorly conditioned muscles of the feet and lower legs are the true cause of most of these familiar kinds of pain in the lower legs, ankles, feet, and toes.

This is the view expressed by Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual.

Big Toe Pain

trigger points toe

Doctors Travell and Simons give an example of this in the big toe pain that is so often attributed to arthritis, "turf toe," or gout.

In many cases, as shown in the drawing, the pain is actually being sent from trigger points in the tibialis anterior muscle of the front of the lower leg.

The referral pattern for these trigger points includes the big toe and the head of the first metatarsal bone, the place where the toe joins the foot. The pain can feel as though it’s actually in the joint.

Physicians who are unaware of these effects are likely to prescribe gout medications for this pain, even when tests fail to confirm the condition. True gout, the deposit of urate crystals in the joints, is caused by uricemia, which is caused by too much uric acid in your blood.

A diet of too much meat and too little water is likely to promote uricemia. Gout and the trigger points that mimic gout often coexist, and uricemia can make your trigger points hard to get rid of. A vitamin C deficiency makes both conditions hard to get rid of.



Trigger points in extensor digitorum longus muscle of the lower leg (shown in the drawing) and the interosseous muscles of the foot can be the cause of hammertoe, claw toe, and painful toes.

These are conditions in which the toes are cramped and drawn up and can’t be straightened either actively or passively. Permanent deformity of the foot can be the eventual result if you never find out about trigger points.

Trigger point therapy can improve the condition even if it has been in place for decades.

Referred Pain

Conventional treatments for foot pain in the form of painkillers, steroid shots, physical therapy, rest, or surgery often prove disappointing. This is not surprising when you know that none of these treatments has any significant effect on trigger points.

The difficulty in understanding and treating trigger points is that they refer pain; that is, they send their pain to some other site. The practitioner too often focuses on the place that hurts, overlooking and failing to treat the actual cause, myofascial trigger points, which can be some distance away.

Trigger points in the eleven muscles of the lower leg account for about half of the pain in your ankles, feet, and toes.

Shin Splints

Note that the two muscles shown on this page are positioned just to the outer side of the shin. Chronic tension from trigger points in these “shin muscles” can result in shin splints, an extremely painful condition caused by stress on muscle attachments.

Although the pain of shin splints is not the same as pain from trigger points, trigger point therapy is the correct treatment, because it removes the chronic tension in the muscles and will thereby remove the pain.


Doctors Travell and Simons warn that shin muscles weakened by trigger points can be a major cause of tripping and stumbling. Your toes tend to catch on steps and the edge of carpets, which can put an elderly person in jeopardy of broken bones or even worse injuries. No matter what your age, if you tend to “fall over your own feet,” trigger points can be the unsuspected cause.

Ankle Pain

Trigger points in lower leg muscles also produce most ankle pain. Many times, an ankle sprain, particularly one with little or no swelling, is nothing more than referred pain from trigger points in the peroneus muscles on the outer side of the lower leg.

When a misstep strongly turns your ankle outward, these muscles are severely overstretched and trigger points form in them. If trigger point therapy gets rid of the pain, it’s unlikely that you have a ligament injury.


Trigger points should be at the top of the list during any examination for pain, numbness, and other abnormal sensations in the lower legs, ankles, or feet. When healthcare practitioners have adequate training and experience, trigger points are easy to locate and treat. In fact, there are ways to treat them yourself quite effectively.

trigger points workbook

In The Trigger Point Therapy Workbook, nationally certified massage therapist Clair Davies has simplified Travell and Simons’s extensive research into myofascial pain and made it accessible to the layman. His innovative methods of self-applied trigger point massage will relieve pain in the lower legs, ankles, and feet when trigger points are the cause.

To find out more about the book and the method, please visit the homepage. To read a growing number of reviews by people who have been helped by the book, take a look at the book’s page at Amazon.com.

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