Case Study: “Plantar Fasciitis” for 3 Years… But the Root Cause Wasn’t Just in the Foot
Sometimes the diagnosis is correct — but the driver behind is somewhere else.
Disclaimer: This case study is based on a real treatment experience. Identifying details have been changed to protect confidentiality. Individual results vary.The Background
A middle-aged patient came to see me after living with a “plantar fasciitis” diagnosis for around three years.
They had done what most motivated people do:
stretching and yoga
general exercise and beach walks
conventional physiotherapy
dry needling (with some short-term relief)
podiatry input
Despite all that effort, they still described their feet and calves as “super tight” and “really hard” — and the symptoms had gradually become bilateral (starting on one side, then progressing to both).
They also had a history of a neck injury from a motor vehicle accident around 10–15 years ago, and they mentioned:
upper neck/occipital tightness that could trigger headaches
finger numbness at night
One more key detail stood out: their foot and calf tightness began after starting a more sedentary job, along with weight gain. They strongly suspected their desk posture was contributing.
The Clues That Made Me Pause
When people are told they have plantar fasciitis, they often expect a simple mechanical explanation: “my heel hurts because the tissue is overloaded.”
But as I listened carefully, a few important clues didn’t fully match the classic pattern:
They reported symptoms could increase with prolonged sitting.
That’s interesting — because while sitting, the feet usually aren’t experiencing significant loading.They didn’t report strong “first-step pain” when getting out of bed in the morning, which is commonly associated with plantar fascia irritation (not always present, but often a helpful sign).
These details didn’t mean their heel pain wasn’t real. It simply suggested this might not be a straightforward “foot-only” story.
What I Found on Assessment
On physical examination:
Cervical range of motion was generally good, with left side-bending a little tighter.
Palpation revealed marked tightness through the upper back/neck region.
The calves were very tight on both sides.
I also checked for neural sensitivity (including a straight leg raise / neurodynamic screen). It was negative — no reproduction of symptoms and no meaningful limitation. Hip range was also fine.
And yes — there was tenderness at the classic heel region where plantar fascia symptoms often present.
So the local signs were there… but the bigger question remained:
Why were the calves and feet acting like they were constantly “bracing,” even during sitting?
A Different Lens: When Tight Muscles Are the “Victim”
In clinic, I often see people who feel tightness everywhere — calves, hamstrings, neck, shoulders — and they’ve tried everything to “loosen it”:
massage, stretching, foam rolling, dry needling… and the relief is often temporary.
One way to understand this pattern is to consider that some muscle tightness isn’t primarily a “short muscle” problem — it can be a protective response driven by the nervous system, often influenced by deeper soft-tissue irritation.
Using my Fascial Counterstrain assessment approach, I found signs suggesting the calf tightness was acting more like a reaction than the starting point.
Further assessment suggested the tissues around the abdominal region (where fascial wrapping around the adipose layers) were showing signs consistent with irritation and protective guarding patterns. When the body perceives irritation (even if it’s not strong enough to create obvious pain signals), it can still trigger spinal reflex activity — the nervous system essentially “turning up tone” in certain muscle groups as a protective strategy.
When calves remain in that “on” state for long enough, they can:
increase pulling forces through the Achilles/heel region (via posterior muscle chain)
change load distribution through the foot
and over time, contribute to irritation in the plantar fascia region
In other words:
the heel can become the painful end-point — even if it’s not the original driver.
Treatment Focus
Treatment was directed toward reducing the underlying protective pattern and addressing the involved fascial systems identified in assessment, rather than only chasing the heel symptoms.
This is an important point:
I’m not “arguing” with the diagnosis label. Instead, I’m looking for what’s sustaining the problem — and what the body hasn’t been able to resolve on its own.
The Outcome Over Two Visits
By the second visit, the patient reported:
calf tightness reduced by around 50%
heel pain had significantly eased
symptoms were no longer interfering with daily activities
That’s the kind of change we aim for — not just temporary loosening, but a meaningful shift in the pattern.
Takeaway: A Diagnosis Is a Label, Not Always the Full Story
A diagnosis is often based on common signs and symptoms — and that can be useful.
But what drives those symptoms can vary from person to person.
My role as a physiotherapist and manual therapist using Fascial Counterstrain is to:
listen carefully to the history
assess patterns beyond the painful area
and reduce obstacles that may be keeping the nervous system and tissues “stuck”
From there, the body often has a better chance to settle, recover, and rebuild — supported by good rest, hydration, movement, and general health.
Want Help With Ongoing Heel Pain or “Tight Calves” That Keep Coming Back?
If you’ve tried stretching, massage, orthotics, or dry needling — and the tightness keeps returning — it may be worth investigating whether the driver is coming from somewhere else.
If you’d like, you can book an appointment and we’ll assess your situation properly and discuss a plan that fits your body and goals.
Frequently Asked Questions
1) Is plantar fasciitis always caused by tight calves or foot mechanics?
Not always. Local overload can be a factor, but some people have symptoms that don’t match a purely mechanical pattern. In those cases, it can help to assess the broader system — including how the nervous system and fascial tissues may be influencing muscle tone and load distribution.
2) Why would heel or foot tightness worsen with sitting?
If symptoms increase during sitting, it may suggest the issue isn’t only due to “impact” or standing load. In some cases, protective muscle tone can be maintained by nervous system reflexes or deeper tissue irritation — meaning the foot can feel tight even without heavy loading.
3) If my straight leg raise test is negative, does that rule out nerve involvement?
A negative test often reduces the likelihood of certain types of nerve sensitivity or nerve root irritation. But the nervous system still influences muscle tone through many pathways. That’s why clinical reasoning and a full-body assessment can be useful.
4) Does Fascial Counterstrain treat plantar fasciitis?
Fascial Counterstrain is not a “one-condition” technique. It’s an assessment-and-treatment approach that aims to identify tissues contributing to pain, tightness, and protective patterns — which may include the foot, calf, or areas that are influencing them.
5) How many sessions do people usually need?
It varies. Some people notice meaningful change quickly, while others need a longer plan depending on complexity, history, and how long symptoms have been present. Your response to the first session often guides what’s realistic.