Foot and Ankle Pain
The first steps in the morning are the worst. Standing on a hard floor for any length of time becomes a calculation. Twenty minutes into the run, the foot starts complaining. Hiking down feels like the ankle could roll, and the ankle has rolled enough times that you don't trust it anymore.
Maybe you've been told it's plantar fasciitis. Maybe you have orthotics that helped, then didn't. Maybe nothing showed up clearly and you were sent home with calf stretches and a tennis ball to roll under your arch. You're starting to wonder if anyone is actually going to figure this out.
I'll give you a hint. It's not because you have 'bad feet.' It's not because of plantar fasciitis or weak ankles — no matter what diagnosis you were handed.
“On the third visit, I am near 100% pain-free.”
-Babe M.
Why It Keeps Coming Back
Foot and ankle pain that won't quit usually isn't a foot problem on its own. The foot is the foundation of the chain — and what happens above the foot determines a lot of what happens at it. If your hip isn't stabilizing, every step still loads the foot in a way it can't manage. If your trunk doesn't align over the foot, every step is a small overload. Most foot pain is the system failing somewhere else and presenting at the foot, where you finally feel it.
Whatever started the pain — a long run, a misstep that turned into a sprain, a slow buildup over months — was not random. The body breaks where it's weakest. For the foot, the weakest point is almost always where a movement pattern has been quietly loading the wrong tissue every step you take. Thousands of steps a day, every day, for years. The pattern was the setup; the event just found it.
This is also why so many patients walk out of a consult having been told they'll need orthotics for life, or that they should stop running, or that the only fix is surgery — sometimes before any meaningful movement-correction work has actually been tried. Sometimes those verdicts are right. Often, though, the pattern is correctable, and the conversation looks different once it has been addressed first.
Two patients with the same diagnosis can need different work. For one, the first steps out of bed are agony, but by mid-day the foot has "warmed up" and is mostly fine — until the next morning. For another, walking around is fine, but a half-mile into a run something starts pulling, and by mile two it's done.
Each is a different system pattern. Each needs a different correction. The standard exercise sheet can't tell them apart, because it isn't asking the question.
The deeper reason most rehab misses this is the same as it is for back pain or any other persistent issue: the diagnostic frameworks that ask these questions aren't part of standard PT training. They're post-graduate specializations that take years of additional study. Most PTs aren't using these tools because they were never trained in them. The exercise sheet is the surface problem. The training gap is the real one.
"I have been to other physical therapists before but James is by far the best."
-Mark P.
Why Strengthening and Stretching Haven’t Been Enough
The orthotics. The calf stretches. The tennis ball under the arch. The ankle alphabets and balance drills. The personal trainer's foot strengthening. The previous round of PT with its band exercises.
None of it is the problem on its own. The problem is what's happening above the foot.
If your hip isn't stabilizing, every step still loads the foot in a way it can't manage. If your trunk doesn't align over the foot, every step is a small overload. Orthotics can support the foot — but they don't teach the foot to function. Calf stretches address one piece of a much larger system.
Good exercise in the wrong direction isn't healing the foot. It's training the compensations harder.
What changes things is treating the system, not the joint.
"James analyzed my problem differently from other doctors and therapists."
- Deborah S.
"I was able to get back to my runs after only 2 visits."
- Amy M.
"After six 1-hour sessions, I am much more mobile so that I can be more active in the things I love to do, such as gardening, exercising, traveling, quilting and just getting about easier."
- Nora W.
How I Work
You'll have one hour. One practitioner. The same practitioner, every visit.
The first session is diagnostic, and it asks two questions at once. From the Movement System Impairment framework: which directions of motion has the foot — and the chain that supports it — become susceptible to, and what daily habits and compensations built that susceptibility? From Dynamic Neuromuscular Stabilization: which deep stabilizing patterns — the ones your nervous system was supposed to run automatically — have gone offline?
Most foot and ankle pain that won't quit involves both. Treatment is built from what I find.
Manual work where joint or soft-tissue restriction is genuinely limiting motion — the foot has 26 bones and 33 joints, and all of them need to move. Targeted retraining of the deep stabilizers — the muscles that hold the arch, the deep hip rotators, the trunk that aligns the body over the foot — when the system that's supposed to support the foot has dropped out. Specific corrections to the chain of motion that's been overloading the foot for months or years.
The exercises you'll practice between sessions are few, deliberate, and tied directly to what your chain needs — not a printed sheet. And the most important work happens in the daily movements you weren't paying attention to: how you stand at the kitchen counter, how you take your first steps in the morning, how you walk to the mailbox, how you push off when you run. The body learns by repetition. Every movement during the day is part of treatment.
You'll leave each session with a clear physical therapy diagnosis, a small set of things to practice, and a real sense of what's actually going on.
Who I Am
Thirty years of clinical practice. Doctor of Physical Therapy from Pacific University. Bachelor of Science in Physical Therapy from Marquette University.
Advanced training in Dynamic Neuromuscular Stabilization (DNS) — one of 110 DNS-certified practitioners in the United States, and currently the only one practicing in Washington state. Advanced training in the Movement System Impairment (MSI) framework developed by Shirley Sahrmann at Washington University. Received Board Certification in Neurologic Physical Therapy in 2005. Former clinical leadership at Cedars-Sinai Medical Center and Kaiser Permanente.
Voxmota is the work I came to Seattle to do.
Do I need a referral or imaging to come in?
No. Washington allows direct access to physical therapy — you can book without a doctor's referral. If you have recent imaging, bring it; it adds context, but it isn't required. What I'm doing is a movement diagnosis, not an imaging interpretation.
What if I think I might need surgery?
If a surgical consult is the right next step, I'll tell you, and I'll help you choose a surgeon worth seeing. Voxmota isn't trying to be every patient's only stop. It's trying to be the right one.
Answers
What if I was told I have plantar fasciitis?
Plantar fasciitis is one of the most commonly given diagnoses for foot pain — and one of the most often incomplete. The plantar fascia might be involved, but the actual driver is usually how the leg is moving: how the foot is loading at heel strike, whether the big toe is engaging at push-off, what the hip and trunk are doing during gait. We start with what's actually happening when your foot hurts, and from there we'll know whether the fascia is the source of the problem or just where the system is registering the breakdown.
How many sessions will I need?
Most plans of care run six to ten visits. We'll know more after the first session, when I've actually seen what's going on. I'd rather give you an honest range than a number designed to commit you.
Book a consultation
A private hour at the Ballard studio, overlooking Puget Sound. Cash-pay. HSA and FSA accepted. No insurance billing.
Or call (206) 486-0467.
I run, hike or work with a trainer. Do I need to stop?
Probably not. But once we've identified what's overloading the foot, you'll know which surfaces, distances, and intensities to ease off, which to keep, and which to add. Most patients who come in with a sport goal find that adjusting the chain — not stopping the activity — is what brings the pain down.