Posterior Tibialis Exercise

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Steps To Develop A Diagnosis In Physical Therapy

“My butt hurts.” A significant proportion of my conversations start with this statement. She continued, “ I have regular active release along with dry needling. I stretch my hamstring ALL THE TIME and I still have pain.” Her frustration was palpable. “I know I have a tight hamstring and there is scar tissue.  But it’s been 8 months.” She assumes the pain must be the hamstring; we call this the pain generator.  The hamstring tendon attaches right where her pain starts. The tightness is over the hamstring muscle belly.  She describes the pain in a clear way that implicates the hamstring.   She made a convincing argument that the hamstring is the issue and the diagnosis has been repeated by multiple medical providers including a physician and two physical therapists. The location matched.  Running increased the pain. Another match. Stretching and manual therapy provided temporary relief. But 8 months into the

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diagram showing heel pain in Tucson caused by different structures in the foot including the plantar fascia and flexor digitorum brevis

7 Signs Your Heel Pain Isn’t Plantar Fasciitis (and What’s Really Causing It)

If you’re dealing with heel pain in Tucson that hasn’t improved despite treatment for plantar fasciitis, you’re not alone. At Smith Performance Center, we often see people who’ve tried injections, stretching, shoe inserts, and ice bottles—yet their heel still hurts. In many of these cases, the real problem isn’t the plantar fascia at all, but a muscle on the bottom of the foot called the flexor digitorum brevis. You wake up, swing your legs to the edge of the bed, and… hesitate. You know this is going to hurt. The good foot moves to the ground first—you learned from that mistake a month ago. You brace and put down the other foot, the ungrateful one that will not get better despite the trip to the podiatrist, the injection, physical therapy, the shoe inserts, the ice bottle massage, and the stretching exercises. The foot touches down. It’s not so bad, you

Read More »

When and Where You Feel Foot Pain During Walking Is Key for Diagnosis

Why the Phase of Pain Matters Foot pain while walking is one of the most common reasons people seek physical therapy. Understanding when and where it hurts can reveal the true cause. Its actually diagnostic. (If you want to read more about how we think about diagnostics, read How to Find the Real Cause of Pain: Our 4-Pillar Diagnosis Process). This means we can figure out the pain generator. That is a large list. It can be the fat pad, your fascia (the most common, incorrect diagnosis), plantar intrinsics (muscles on the bottom of the foot which is primarily the flexor digitorum brevis, abductor hallucis, and abductor digiti minimi), the flexor hallucis longus, the tibial nerve, the medial or lateral plantar nerve, the calcaneus, the talus, the bones of the midfoot and forefoot, the foot and ankle joints, ligaments, the hallux (big toe), or the little toes. It does not

Read More »

Steps To Develop A Diagnosis In Physical Therapy

“My butt hurts.” A significant proportion of my conversations start with this statement. She continued, “ I have regular active release along with dry needling. I stretch my hamstring ALL THE TIME and I still have pain.” Her frustration was palpable. “I know I have a tight hamstring and there is scar tissue.  But it’s been 8 months.” She assumes the pain must be the hamstring; we call this the pain generator.  The hamstring tendon attaches right where her pain starts. The tightness is over the hamstring muscle belly.  She describes the pain in a clear way that implicates the hamstring.   She made a convincing argument that the hamstring is the issue and the diagnosis has been repeated by multiple medical providers including a physician and two physical therapists. The location matched.  Running increased the pain. Another match. Stretching and manual therapy provided temporary relief. But 8 months into the

Read More »
diagram showing heel pain in Tucson caused by different structures in the foot including the plantar fascia and flexor digitorum brevis

7 Signs Your Heel Pain Isn’t Plantar Fasciitis (and What’s Really Causing It)

If you’re dealing with heel pain in Tucson that hasn’t improved despite treatment for plantar fasciitis, you’re not alone. At Smith Performance Center, we often see people who’ve tried injections, stretching, shoe inserts, and ice bottles—yet their heel still hurts. In many of these cases, the real problem isn’t the plantar fascia at all, but a muscle on the bottom of the foot called the flexor digitorum brevis. You wake up, swing your legs to the edge of the bed, and… hesitate. You know this is going to hurt. The good foot moves to the ground first—you learned from that mistake a month ago. You brace and put down the other foot, the ungrateful one that will not get better despite the trip to the podiatrist, the injection, physical therapy, the shoe inserts, the ice bottle massage, and the stretching exercises. The foot touches down. It’s not so bad, you

Read More »

When and Where You Feel Foot Pain During Walking Is Key for Diagnosis

Why the Phase of Pain Matters Foot pain while walking is one of the most common reasons people seek physical therapy. Understanding when and where it hurts can reveal the true cause. Its actually diagnostic. (If you want to read more about how we think about diagnostics, read How to Find the Real Cause of Pain: Our 4-Pillar Diagnosis Process). This means we can figure out the pain generator. That is a large list. It can be the fat pad, your fascia (the most common, incorrect diagnosis), plantar intrinsics (muscles on the bottom of the foot which is primarily the flexor digitorum brevis, abductor hallucis, and abductor digiti minimi), the flexor hallucis longus, the tibial nerve, the medial or lateral plantar nerve, the calcaneus, the talus, the bones of the midfoot and forefoot, the foot and ankle joints, ligaments, the hallux (big toe), or the little toes. It does not

Read More »