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Click on the image below to use our Trigger Point Locator video on YouTube to learn about the trigger points that are causing a specific pain. Our assessment and treatment philosophy integrates modern neuroscience and knowledge regarding the neurophysiology of pain into a traditional biomechanical model of joint function. Our site is a gateway to treatment, but also functions as a platform for gathering information relevant to pain, injury and rehabilitation.
For the local community of Coogee, we provide Physiotherapy, Massage, Dietetics and Exercise Therapy services for a broad range of aches, pains and injuries. The tibialis anterior trigger point causes pain in the front of the ankle and on the big toe. This trigger point weakens the tibialis anterior muscle which is responsible for raising (and lowering) the foot at the ankle as you walk. Location: The tibialis anterior muscle lies just under the skin in the shin region of the lower leg. Function: The tibialis anterior primarily functions to prevent foot slap after the hell-strike phase of walking by performing an eccentric (lengthening) contraction. The toe extensors (extensor digitorum longus and extensor hallicus longus) assist the tibialis anterior in dorsiflexion of the foot. The gastrocnemius, soleus, and tibialis posterior are plantar flexors (pushing down) of the foot and are the primary muscles that oppose the dorsiflexion of the tibialis anterior. The peroneus longus and peroneus brevis produce eversion (sole turning slightly outward) of the foot and oppose the inversion of the foot produced by the tibialis anterior. As show in the diagram above, this trigger point refers pain strongly to the front and inside of the ankle, and also to the top and inside of the big toe.
Foot drop: clients will find it difficult to lift the foot as they take a step and will drag it across the ground, causing them to trip or fall.
Foot slap: the client’s foot may slap down (uncontrolled) immediately after heel strike during walking.
Typically does not produce pain at night, but may if the foot is kept in a plantar flexed (down) position during sleeping. Muscle Weakness Test: With the client laying face-up on the table, the therapist inverts (turns the sole inward) the affected foot and then asks the client to try to lift (dorsiflex) the foot against a gentle resistance applied by the therapist. Catching a toe on a step as you lift the foot to walk up a stair, or tripping over an unseen object while walking, can easily overload this muscle and initiate trigger point activity in it. Big Toe Extensor Trigger Point: Referred pain from the trigger point in the extensor hallicus longus muscle concentrates on the top of the foot between the ankle and big toe (over the head of the first metatarsal bone) , but may also spillover into the front of the ankle and top of the big toe (resembling the referred pain from the tibialis anterior trigger point).
Toe Extensor Trigger Points: Referred pain from trigger points in the toe extensor muscles (extensor digitorum longus and brevis) is also projected to the top of the foot but is found more laterally on the top of the foot than the referred pain from the tibialis anterior. Peroneus Tertius Trigger Point: The trigger point in the peroneus tertius muscle also refers pain to the front of the ankle but it can be distinguished from tibialis anterior referred pain by the fact that it doesn’t refer pain to the big toe. Anterior Compartment Syndrome: A serious disorder that can result from trauma to the shin region, overuse, or muscle tearing that is characterized by pain and swelling in the front of the leg that compromises the local circulation.
What is unique about these trigger points is that they don’t have to be actively producing pain to cause big problems. Muscle Actions: Contraction of the gastrocnemius primarily produces plantar flexion of the foot, though it may also supinate the foot and assist with flexion of the knee. The two lateral trigger points in the lateral head mirror the positioning of the medial trigger points, except that they lie slightly more distal (towards the foot) by about a half-inch.
The diagram above also shows the referred pain patterns associated with the gastrocnemius trigger points. The lower medial trigger point is the only gastrocnemius trigger point that has an extended pain referral pattern.
The upper medial and upper lateral trigger points refer pain locally to the back of the knee.

S1 Radiculopathy: The pain associated with compression of the S1 nerve, namely posterior thigh and calf pain, may be mimicked by the posterior knee and calf pain produced by the gastrocnemius trigger points. Thrombophlebitis: The calf pain associated with deep vein thrombosis can be very similar to that produced by active gastrocnemius (and soleus) trigger points, though other symptoms (such as redness of the skin in the lower leg) are not produced by trigger point activity.
Posterior Compartment Syndrome: A serious condition of the calf region marked by diffuse pain and swelling. More information about these trigger points, as well as complete step-by-step instructions for locating and releasing them, can be found in the Trigger Point Therapy for Gastrocnemius Video + 17-Page PDF Booklet. Some doctors may mistakingly diagnose this pain complaint as Posterior Tibialis Tendon Syndrome or Achilles Tendonitis, but chronic, unaddressed trigger point activity in this muscle (and the soleus muscle) can be the cause of these conditions and mimic their symptoms.
Location: The tibialis posterior is a a long, thin muscle that lies deep in the calf, sandwiched between the soleus muscle and the interosseus membrane that runs between the tibia and fibula bones.
Function: The tibialis posterior functions to stabilize the ankle and foot during walking and running and to distribute the body weight evenly across the bones of the foot. Muscle Actions: The tibialis posterior assists the gastrocnemius and soleus muscles with plantar flexion  (downward push) of the foot at the ankle.
The gastrocnemius, soleus, and tibialis posterior muscles all act as plantar flexors of the foot.
The toe flexors (flexor digitorum longus and flexor hallucis longus) also assist the tibialis posterior with inversion of the foot. The peroneus longus and brevis produce eversion of the foot, and thus oppose the inversion of the foot produced by the tibialis posterior and tibialis anterior muscles.
The tibialis anterior produces dorsi-flexion (lifting) of the foot at the ankle and thus opposes the plantar flexion produced by the gastrocnemius, soleus, and tibialis posterior. Because the tibialis posterior lies deep to the soleus muscle, it’s important to relax the soleus by releasing any trigger points in it before attempting to locate the tibialis posterior trigger points. As show in the diagram above, this trigger point refers strongly to the Achilles tendon region, extending up into the calf and down across the bottom of the foot (not shown). Any walking or running surface that requires extra foot stabilization, such as gravel or uneven pavement will exasperate the pain. Single-Heel Rise Test: A client with an active tibialis posterior trigger point will not be able to stand on the affected leg and rise up onto the ball of that foot. While standing, the person’s foot on the affected side will be both flat-footed (no arch) and everted (toes pointing out). Morton’ Foot Structure: A variation of the boney structure of the foot where the base of the second toe (next to the big toe) is farther forward than the base of the big toe.
Locating and releasing this trigger point can be a little tricky because it is located so deep in the calf. This video is interactive and must be viewed on a computer to make use of the interactive elements.
The pain in the big toe can be mistaken for gout, and the metabolic condition that causes gout may also irritate the trigger points in the lower leg muscles.
So when someone with this trigger point tries to take a normal step, their foot kind of drags behind and then slaps down after their heel strikes the ground. It is located just lateral to the boney edge of the Tibia in the upper half of the shin region.
It also contracts to help pull the leg and body forward over the planted foot during walking and running. It runs down the front of the lower leg forming a tendon that passes around in front of the inside ankle bone and into the arch of the foot, attaching to the medial cuneiform bone and the first metatarsal bone. When the foot is hanging free, contraction of this muscle also produces inversion (sole of the foot turns inward) and adduction (toes point inward) of the foot.
Spillover pain may also occur in the shin and along the top of the foot if the trigger point activity is intense enough.

Make sure the client doesn’t compensate for weakness in the tibialis anterior by using their toe extensor muscles, which would be evident by them lifting (extending) their big toe as they try to lift their foot. Latent trigger points in this muscle are frequently responsible for seriously painful calf cramps. Its pain tends to cover the whole of the calf region and will concentrate strongly in the instep region of the foot. Additionally, the S1 radiculopathy pain may actually cause trigger point activity in this muscle (and other muscles) which might persist after the radiculopathy (or any lumbar radiculopathy) has been surgically decompressed (also known as post-laminectomy pain). Trigger point activity in the gastrocnemius and soleus muscles can be a mediator of the calf pain and cramping associated with this condition.
It also produces inversion and adduction of the foot when the foot is not weight bearing (hanging free). This trigger point is located near the muscle’s origination, about half-way between the tibia and fibula bones in the upper third of the lower leg.
The muscles inability to contract strongly will prevent the bones in the foot from locking together to form a proper arch, thus the foot will not be able to bear the weight of the body on the ball of the foot. The therapist then everts (toes outward) and abducts (sole of the foot faces slightly to the outside), and then attempts to gently dorsi-flex the foot by pushing the ball of their foot towards their knee-cap. Typically it presents as a burning pain in the Achilles tendon region at the beginning of a run that dissipates gradually, only to return strongly after the run is finished. The inversion of the foot produced by this muscle only occurs when the foot is dangling, not when it is planted and bearing the body’s weight. When these trigger points are active, they refer pain to the back of knee, calf, and instep of the foot regions. It lies deep in the calf musculature and causes intense pain and burning in the Achilles tendon region. Its tendon travels down the inside of the lower leg to wrap around the medial malleolus (inside ankle bone) and then fans out to attach to each of the bones that create the arch of the foot (primarily the navicular bone). The client is also likely to experience pain along the medial malleolus (inside ankle bone) as they attempt this test.
If present, the trigger point in the tibialis posterior should painfully resist the dorsi-flexion of the foot during this test. This condition causes side-to-side instability in the foot which can overload the muscles that act to stabilize the foot, such as the peroneal and tibial muscle groups. The referred pain from trigger points in the soleus and tibialis posterior muscles can easily mimic this condition.
Release the trigger point in this muscle and the foot drop goes away, though it may take a couple treatments and some time for the muscle to strengthen in chronic cases. Call me crazy, but sometimes I think every case of myofascial pain (from headaches to foot pain) has it’s origin in the calf muscles. The pain will also frequently spread to the calf, the heel, and over the entire surface of the sole of the foot (including the bottom of the toes).
To exclude the involvement of the toe flexor muscles in this test, the therapist should gently bend all five toes back towards the knee-cap (toe extension) after the foot has reached its limit of dorsi-flexion. It should be noted that the referred tenderness to the sole of the foot from the tibialis posterior trigger point will often make wearing an orthotic in the shoe too painful to be effective.
If extending the toes back doesn’t produce any additional pain, then only the tibialis posterior muscle is involved.

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