- 1008 Victoria Road West Ryde NSW 2114 Australia
- Thursday: 1:00pm – 6:00pm
By Dr Don Kim · Chiropractor & Acupuncturist · TOP Chiropractic Acupuncture, West Ryde
The foot and ankle are the foundation of every movement your body makes. Every step, every squat, every climb distributes force upward through the kinetic chain. When the foundation is compromised — from an old ankle sprain, chronic tightness, tendon overload or structural change — every structure above it compensates. The knee, the hip, the pelvis and the lumbar spine all adjust their mechanics in response to what the foot is doing.
This is why foot and ankle problems are so commonly undertreated. The local pain is addressed — the plantar fascia is stretched, the ankle is supported with orthotics, the Achilles is rested — but the mechanical contributors from the calf, the hip and the lumbar spine that are driving the overload from above are never examined. The foot settles temporarily and then fails again under the same conditions.
At TOP Chiropractic Acupuncture in West Ryde, every foot and ankle presentation is assessed as part of the full lower limb and lumbar chain. We identify not only what is happening at the foot, but what is driving it from above — and what the foot is driving upward into the rest of the body.
Foot and ankle pain presents in several distinct ways depending on the structure involved, the mechanism of overload, and the patient’s activity and occupation profile.
CONDITION | WHO IT AFFECTS | WHAT’S HAPPENING |
Plantar fasciitis | Runners, desk workers, teachers, retail and hospitality workers | Inflammation and degeneration of the plantar fascia at its calcaneal insertion. The classic presentation is sharp heel pain with the first steps in the morning that eases after a few minutes of walking but returns with prolonged loading. The plantar fascia is the origin of the Superficial Back Line — chronic plantar fasciitis rarely resolves without addressing the posterior chain tension that is loading it from above. |
Achilles tendinopathy | Runners, gym athletes, middle-aged adults returning to exercise | Degenerative changes in the Achilles tendon, either at its calcaneal insertion (insertional) or in the mid-tendon 2–6 cm above the heel. Produces localised thickening, morning stiffness and pain with loading — particularly running, jumping and stair climbing. The most evidence-supported intervention is progressive eccentric loading. Rest alone produces consistent recurrence. |
Lateral ankle sprain and instability | Athletes, dancers, those with a history of previous ankle sprains | Acute or chronic injury to the lateral ankle ligaments — most commonly the ATFL and CFL. A single unrehabilitated sprain creates mechanical and neuromuscular instability that predisposes to repeated sprains. Chronic ankle instability changes gait mechanics from the ground up, contributing to knee, hip and lumbar loading patterns that persist long after the ankle pain settles. |
Peroneal tendinopathy | Runners, dancers, patients with chronic ankle instability | Overload of the peroneus longus and brevis tendons as they course behind the lateral malleolus. Produces lateral ankle and hindfoot pain with activity, often confused with lateral ligament injury. Common in patients who have over-pronated or supinated gait and in those whose ankle instability has caused chronic peroneal guarding. |
Posterior tibial tendinopathy | Middle-aged women, flat-footed patients, prolonged standers | Degeneration of the posterior tibial tendon as it passes behind the medial malleolus. The primary inverter and dynamic arch supporter of the foot. When it fails, the arch progressively collapses and forefoot abduction develops. Produces medial ankle pain and fatigue with prolonged standing. Early identification and loading is critical — neglected cases progress to rigid flatfoot deformity. |
Morton’s neuroma | Women in narrow footwear, runners, forefoot strikers | Perineural fibrosis of the interdigital nerve — most commonly between the third and fourth metatarsals. Produces burning, tingling or a sensation of walking on a stone in the forefoot. Aggravated by tight footwear and forefoot loading. Often co-exists with altered forefoot mechanics from collapsed transverse arch. |
Stress fractures | Runners increasing mileage, military personnel, osteoporotic patients | Fatigue fractures from repetitive loading that exceeds bone remodelling capacity. Most common in the second metatarsal, navicular, calcaneus and fibula. Presents as localised bone pain that worsens progressively with activity and eases completely with rest. Requires imaging confirmation and load restriction before return to activity. |
Hallux valgus and bunion pain | Women, patients with hereditary foot type, long-term narrow footwear users | Medial deviation of the first metatarsal with lateral deviation of the hallux. Produces pain at the bunion, altered forefoot load transfer, and secondary changes throughout the foot and lower limb. Conservative management focuses on load redistribution, first ray mobility and intrinsic foot muscle strengthening rather than the deformity itself. |
⚠️ Not all foot and ankle pain is local pathology. Lumbar nerve root compression at L4, L5 or S1 commonly refers pain, numbness and weakness into the foot and ankle. A patient with foot symptoms who also has lower back stiffness, calf tightness or altered sensation should have their lumbar spine assessed before local foot treatment is applied. |
The plantar fascia is not just a structure in the foot. It is the origin of the Superficial Back Line — the fascial and muscular chain that runs from the sole of the foot through the calf, hamstrings, sacrotuberous ligament, erector spinae, thoracic fascia and suboccipital muscles all the way to the base of the skull. When the foot is under chronic stress, that tension travels upward through the entire posterior chain.
This is why patients with long-standing plantar fasciitis often also present with calf tightness, hamstring restriction, low back stiffness and even cervical tension. And it is why resolving the plantar fasciitis often requires releasing the posterior chain above, not just treating the fascia at the heel.
When the lumbar spine and hip drive it ↓ Lumbar restriction and hip extension limitation change how load is distributed through the pelvis and lower limb with every step. A patient who cannot fully extend their hip during gait will pronate excessively at the foot to compensate — overloading the plantar fascia, the posterior tibial tendon and the medial arch. Treating the foot without restoring hip extension and lumbar mobility means treating the symptom while the cause continues. | When the calf and Achilles are the driver → The gastrocnemius and soleus are the most mechanically demanding muscles in the body — they absorb body weight with every step and propel it forward. Chronic calf tightness restricts ankle dorsiflexion, which forces the foot to compensate during the stance phase of gait. The result is abnormal plantar fascia loading, increased metatarsal stress and altered ankle mechanics that create overuse pathology at multiple foot and ankle structures simultaneously. | When the foot drives the chain upward ↑ An unrehabilitated ankle sprain changes gait mechanics for years after the pain has resolved. The altered proprioception and peroneal weakness from even a mild lateral ankle sprain changes how the knee tracks, how the hip loads and how the pelvis sits. We have seen cervical tension, low back pain and gluteal tendinopathy that trace back to a poorly managed ankle injury years earlier. The foot is the foundation — its dysfunction travels. |
What makes our approach different is that we assess the entire chain — not just the painful foot structure. A patient with plantar fasciitis may have posterior chain tension from the hamstrings that is maintaining the fascial load regardless of local treatment. A patient with Achilles tendinopathy may have restricted hip extension that is overloading the calf with every stride. Identifying and addressing these contributing factors is what produces lasting resolution rather than temporary symptom relief. |
In practice, the most common chains we identify driving foot and ankle pain include:
The morning heel pain pattern | The patient wakes, takes their first steps and experiences sharp heel pain that eases after a few minutes. This is plantar fasciitis — but the cause is rarely limited to the foot. During sleep, the foot rests in plantarflexion, shortening the plantar fascia. The morning pain is the fascia being loaded before it has warmed and lengthened. The reason it does not resolve with stretching alone is that the posterior chain above — tight calves, restricted hamstrings, lumbar stiffness — maintains the fascial load throughout the day and reloads it every night. |
The runner pattern | The runner increases mileage, introduces speed work, or changes surface. Within weeks, Achilles or plantar fascia symptoms develop. The loading pattern is clear, but the cause is often proximal: restricted hip extension forces the calf to work harder during late stance, generating excess load through the Achilles with every stride. Reduced ankle dorsiflexion changes forefoot mechanics and increases plantar fascia tension with every footstrike. Addressing the hip and ankle mechanics is what allows the runner to return to full mileage without recurrence. |
The unrehabilitated ankle pattern | The patient sprained their ankle months or years ago. It ‘healed’ but was never properly rehabilitated. They now have intermittent lateral ankle pain, a feeling of the ankle ‘giving way’, and perhaps knee, hip or low back symptoms that seem unrelated. The chronic instability from the original injury — incompletely healed ligaments and impaired proprioception — has created a persistent compensatory pattern through the entire lower limb chain. Rebuilding peroneal strength and ankle proprioception is the only intervention that breaks the cycle. |
The standing occupation pattern | The teacher, nurse, chef or retail worker who stands on hard floors for 6 to 8 hours per day. The foot’s intrinsic muscles fatigue and the arch progressively collapses under sustained load. The posterior tibial tendon works overtime to maintain the medial arch and eventually undergoes tendinopathic change. The plantar fascia accumulates cumulative strain across thousands of steps on unforgiving surfaces. Footwear, surface, load management and intrinsic foot strengthening are all part of the treatment picture. |
Every foot and ankle presentation begins with a thorough assessment — evaluating the ankle joint mechanics, the plantar fascia, the Achilles tendon, the arch structure, the calf complex, the hip extension pattern and the lumbar chain. Where ankle instability is present, proprioceptive and peroneal strength testing is included. Treatment is structured around what the assessment finds.
Acupuncture Directly targets the plantar fascia, Achilles tendon insertion, peroneal and posterior tibial tendons for pain modulation and neural desensitisation. Acupuncture to the calf and posterior chain reduces the myofascial tension that is maintaining fascial load at the foot. Particularly effective for plantar fasciitis, Achilles tendinopathy and peroneal tendinopathy where sustained tissue tension is a primary driver. | Chiropractic mobilisation Restores ankle joint dorsiflexion where restriction is identified as a contributing factor. Addresses the subtalar, midfoot and first metatarsophalangeal joints where stiffness alters foot mechanics during gait. Lumbar and hip chain work is included where proximal restriction is contributing to altered lower limb loading — which is present in the majority of chronic foot presentations. |
Soft tissue and calf release Direct release of the gastrocnemius, soleus and deep posterior compartment muscles that maintain posterior chain tension through to the plantar fascia and Achilles. Fascial release to the plantar surface where thickening and restriction are identified on palpation. Combined with lumbar and hip work to maintain the posterior chain improvements across sessions. | Shockwave therapy The highest level of evidence for shockwave therapy exists for plantar fasciitis and Achilles tendinopathy — the two most common chronic foot conditions we treat. Where the fascia or Achilles tendon has been chronically loaded and has undergone degenerative change, shockwave delivers focused acoustic energy that restarts the stalled healing response. Combined with the loading programme and never used in isolation. |
Isometric calf loading The first stage of Achilles tendon rehabilitation. Sustained calf raises on a flat surface, held for 30–45 seconds. Reduces tendon pain by modulating the nervous system response and begins stimulating collagen remodelling without exceeding the tendon’s capacity. The starting load is determined individually — often lighter than the patient expects. | Eccentric heel drops The evidence-based gold standard for Achilles tendinopathy rehabilitation. Controlled lowering of the heel below the step level with a slow 3–5 second descent. For midportion tendinopathy, performed with a straight knee and a bent knee to target both heads of the calf complex. Progressed in load, speed and surface over weeks. The same eccentric loading principle applies to plantar fasciitis and peroneal tendinopathy rehabilitation. | Proprioception and return to sport Single-leg balance progression, peroneal strengthening with resistance band, hopping and landing mechanics for athletes, and sport-specific loading patterns. Where ankle instability is present, neuromuscular control retraining is the primary intervention that reduces re-sprain risk. Gait retraining is included where altered mechanics were identified as a contributing driver. |
Rest is the most commonly recommended treatment for plantar fasciitis and Achilles tendinopathy. It reduces pain temporarily by removing the provocative load. But the degenerated collagen, the disrupted tendon architecture and the underlying mechanical drivers remain unchanged. When the patient returns to activity, the same conditions that created the problem recreate it.
Tendons adapt to the loads placed on them. When a tendon is loaded progressively — starting below its pain threshold and increasing systematically — the collagen reorganises, the tendon thickens and its load capacity increases. This is the mechanism behind the eccentric loading protocol for Achilles tendinopathy: the slow, controlled descent loads the tendon eccentrically, creating the mechanical stimulus for structural remodelling that rest cannot provide.
At TOP Chiropractic Acupuncture, loading begins within the first one to two weeks of treatment — at an intensity the tendon can tolerate without next-day flare. We find that threshold, start below it, and progress systematically. The speed of progression depends on the stage and chronicity of the condition. What does not change is the principle: the tendon and fascia get stronger by being loaded correctly, not by being avoided.
Plantar fasciitis is one of the most commonly treated and most commonly mismanaged conditions in foot care. Patients are advised to stretch the calf, use orthotics, take anti-inflammatories and rest. These interventions address the symptoms without identifying the cause.
The most important question with plantar fasciitis is not ‘what is irritating the fascia’ but ‘why is the posterior chain loaded to the point where the fascia cannot tolerate it’. In a significant proportion of patients, the answer lies in the calf and posterior chain above — not the foot below. Releasing the gastrocnemius, addressing lumbar restriction, and rebuilding the foot intrinsics to support the arch from within are consistently more effective than local fascia treatment alone.
Cortisone injection is commonly offered for plantar fasciitis. As with elbow and shoulder tendinopathy, cortisone provides strong short-term pain relief but inferior long-term outcomes compared to progressive loading. There is also a risk of plantar fascia rupture with repeated injection. Cortisone has a role when pain is severe enough to prevent participation in a loading programme — but as a standalone treatment, it addresses the pain while leaving the structural and mechanical drivers unchanged.
Most foot and ankle conditions respond well to conservative treatment. Where a foot is not improving within the expected timeframe, or where the clinical picture suggests a structural problem, we recommend further investigation.
Diagnostic ultrasound is the first-line investigation for plantar fasciitis, Achilles tendinopathy, peroneal and posterior tibial tendinopathy. It visualises the tendon and fascia directly, identifies tears, thickening and degenerative change, and can be performed quickly. MRI is recommended where stress fracture, navicular pathology, talar osteochondral lesion or complex soft tissue injury is suspected.
At TOP Chiropractic Acupuncture, we set clear criteria at the start of your treatment plan for when imaging would be recommended. Where lumbar referral is suspected as the primary driver of foot symptoms — which is more common than most patients expect — appropriate lumbar assessment and imaging is arranged. The decision to image is based on your clinical progress and objective findings, not delayed until frustration sets in.
At the end of your treatment plan, we perform a full re-examination — retesting everything from your first visit and comparing the results side by side. This gives you a clear, objective picture of how much you have improved.
There is no guesswork and no vague ‘how does it feel’ — we measure your ankle dorsiflexion range, your single-leg calf raise capacity, your plantar fascia provocation response, your Achilles tendon load tolerance, your proprioception and balance, and your functional capacity against your original baseline. Those results determine whether you are ready for maintenance, need continued treatment, or require referral. The numbers make the decision.
Chiropractic Ankle joint dorsiflexion. Subtalar and midfoot mobility. Lumbar and hip chain mechanics. Addresses the structural contributors above the foot that maintain posterior chain tension. | Acupuncture Pain modulation at the plantar fascia, Achilles, peroneal and posterior tibial tendons. Posterior chain release from calf to suboccipital. Neural desensitisation for chronic and sensitised presentations. | Shockwave Highest evidence base for plantar fasciitis and Achilles tendinopathy. Restarts stalled healing in degenerated tendon and fascial tissue. Combined with manual therapy and the progressive loading programme. | Rehabilitation Eccentric loading for Achilles and plantar fascia. Peroneal strengthening for ankle stability. Proprioception retraining. Foot intrinsic strengthening. Gait retraining where altered mechanics are identified. |
⚠️ Foot pain following a significant injury — particularly a high-force ankle roll, a fall or a direct impact — may indicate a fracture, ligament rupture or osteochondral lesion. If you cannot fully weight-bear, have significant swelling or bruising, or if the pain does not ease within 48 to 72 hours of the injury, seek medical assessment and imaging before beginning conservative treatment. |
Book an assessment at TOP Chiropractic Acupuncture if you are experiencing:
Heel pain on your first steps in the morning that is not improving with stretching or rest Achilles pain, thickening or stiffness that limits your running or training A history of ankle sprains with persistent instability or a feeling the ankle ‘gives way’ Foot or ankle pain that flares after exercise and takes days to fully settle Pain, numbness or tingling into the foot or toes — particularly combined with lower back symptoms Medial arch pain or fatigue that worsens with prolonged standing or walking Forefoot pain or burning between the toes with footwear or weight-bearing Foot or ankle symptoms that have not responded to orthotics, rest or previous treatment |
Dr Don Kim is a dual-qualified chiropractor and acupuncturist at TOP Chiropractic Acupuncture in West Ryde. He holds a Masters of Chiropractic, Bachelor of Chinese Medicine and Bachelor of Acupuncture, and has been treating foot, ankle and lower limb conditions since establishing the clinic in 2016. As an active Ironman and endurance athlete, Dr Don has direct experience of the foot and ankle demands of running and cycling, and regularly treats runners, cyclists and active patients from the West Ryde and Ryde area who need their foundation functioning correctly for their sport, training and daily life.
