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Category: Diagnosis and Home Plan Development

4 Ways Individuals With Heel Pain Can Make Their Pain Go Away

Craig Smith January 31, 2023

Why is your heel pain not getting better? Heel pain is a common, painful foot condition leading internet searches for “cures to heel pain” or “treatments for plantar fasciitis.” The pain resolves with time if the cause of symptoms is removed, but up to 10% of individuals with heel pain do not get better. These chronic sufferers try everything to get rid of the pain including plantar fascia releases, injections, and pain medications. The causes of heel pain are numerous, ranging from plantar tendinopathies like the flexor digitorum brevis, nerve involvement with tarsal tunnel syndromes or lateral plantar nerve, low back referrals, and double crush syndrome to fat pad injuries. The answer is not more stretching and new orthotics. If you are stuck with heel pain and the typical treatment for plantar fasciitis is not making you feel better, then you likely have a different problem and require a different

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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)

Craig Smith January 31, 2022

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

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5 Steps To Develop A Diagnosis In Physical Therapy

Craig Smith September 2, 2020

“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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Trigger Management Plan in Physical Therapy

Trigger Management: Why physical therapy exercises are not enough to get you better?

Craig Smith August 6, 2019

What is a Trigger? We use the term trigger as a catch-all term for the activities and movements during the day that makes symptoms worse.  Trigger investigation is critical because they are the bane of feeling better. ​ The term, trigger, is an event that causes something else to happen.   You trigger the headache when you look over your shoulder. You trigger back pain when you move from sitting to standing. You trigger the shoulder pain when you reach for the shelf.   Sounds simple?  Unfortunately, determining all of the triggers to your symptoms is as difficult as it is important.   We obsess about triggers and draw boxes and lines going all over! Why do we obsess on trigger management instead of building a huge list of physical therapy exercises? Imagine this scenario.  I am hitting a nail into the wall. Instead of hitting the nail, I manage

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Smith Performance Center Tucson

Why Do Athletes Cramp?

Craig Smith June 23, 2018

  Cramping is at the top of the list of common problems that we think are misdiagnosed and mismanaged. Watch the following video to learn more!  

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Craig Smith