By Dr. Yoon Jeon, MChiro, MB, BSc, Dip.TCM, PGCert.
Case Presentation
A 40-year-old nurse presented with persistent heel pain consistent with plantar fasciitis, ongoing for more than one year.
The pain was most pronounced during weight-bearing activities, particularly with the first steps in the morning and after prolonged standing during work shifts.
The patient had undergone multiple prior treatments, including:
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Physiotherapy
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Taping
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Analgesic medication
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Shockwave therapy
Despite these interventions, symptoms had remained largely unchanged, with minimal or no sustained improvement.
Clinical Assessment
The clinical presentation was consistent with chronic plantar fasciitis, likely involving:
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Mechanical overload of the plantar fascia
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Reduced ankle and foot joint mobility
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Soft tissue tightness, particularly involving the calf–Achilles complex
Chronicity and poor response to previous treatments suggested persistent biomechanical dysfunction and local tissue irritation.
Treatment Approach
A combined, multi-modal conservative treatment plan was implemented:
Foot and Ankle Joint Manipulation
Manual techniques were applied to improve joint mobility and reduce mechanical stress across the plantar fascia.
Soft Tissue Therapy
Focused deep tissue (stroking) massage was applied to the plantar fascia to reduce tension and improve local circulation.
Electro-Acupuncture
Electro-acupuncture was used to modulate pain, reduce local inflammation, and promote tissue healing.
Kinesiology Taping
Supportive taping was applied to offload the plantar fascia and assist functional movement during weight-bearing.
Rehabilitation Programme
A structured home programme was prescribed, including:
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Achilles tendon stretching
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Plantar fascia-specific stretching
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Self-massage using a roller
The aim was to improve tissue flexibility, reduce mechanical strain, and support long-term recovery.
Clinical Outcome
After two treatment sessions:
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Noticeable reduction in heel pain
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Improved tolerance to weight-bearing activities
Over a 6-week period:
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Progressive symptom resolution
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Return to normal daily and occupational activities without pain
At completion of care:
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The patient was fully recovered
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No residual symptoms were reported
Clinical Summary
This case highlights the importance of addressing underlying biomechanical factors in chronic plantar fasciitis, particularly in patients who have not responded to standard treatments.
A combined approach using joint manipulation, soft tissue therapy, acupuncture, and targeted rehabilitation may provide effective outcomes, even in long-standing cases.
References
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Buchbinder R (2004). Plantar fasciitis. New England Journal of Medicine, 350(21), 2159–2166.
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Karl B Landorf & Roxanne Landorf (2008). Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Archives of Internal Medicine.
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Cleland JA et al. (2009). Manual physical therapy and exercise versus electrophysical agents for plantar fasciitis. Journal of Orthopaedic & Sports Physical Therapy.
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Francesco Cotchett et al. (2014). Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Physical Therapy.
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A Crawford & C Thomson (2003). Interventions for treating plantar heel pain. Cochrane Database of Systematic Reviews.
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Michael D Scher et al. (2009). Plantar fascia-specific stretching for the treatment of plantar heel pain. Journal of Bone and Joint Surgery.
