Posture and Body Balance: Lessons from 25 Years of Pain Care

Hello. I'm Dr. Ahn Jae-seok of Seoul Cheongdam Dr. Anapa Clinic (a clinic focused on pain medicine, dermatology, and rehabilitation medicine). As a board-certified anesthesiology and pain medicine specialist, I have treated a wide range of pain patients for about 25 years—headaches, neck and shoulder pain, low back pain, knee pain, calf pain, ankle pain, and foot pain. Along the way, one principle has become central to my practice: "Don't look only at the painful spot—also find out why that area keeps being overloaded." Today I'd like to talk about a common condition: plantar fasciitis and heel and sole pain.

If your heel hurts with your first steps in the morning, start with the structure of the plantar fascia

The plantar fascia is a band of fibrous tissue running from the heel bone to the toes, and when repetitive load builds up, pain tends to be most noticeable with the first steps in the morning.

The plantar fascia supports the arch of the foot and absorbs shock when you walk or run. When this tissue is repeatedly overloaded, pain can develop on the inner side of the heel or the sole. Typical symptoms include:

• Pain with your first steps after getting up in the morning
• Pain returning when you stand up after sitting for a long time
• Heel pain flaring again after standing or walking for a long time

Pain caused by repetitive load on the plantar fascia has been reported to recur for anywhere from a few weeks to several months.

But the more important question here is: "Why is this particular area repeatedly overloaded?"

Sole pain may not be just a foot problem

If you look for the cause of sole pain only in the foot itself, treatment may keep repeating, so it's important to also assess the body's overall left-right and front-back balance.

Over 25 years of treating pain patients, one thing I've watched closely is the body's left-right and front-back balance. For example, people who habitually sit for long periods with their weight on one buttock are prone to having the trunk and pelvis tilt to one side. When this imbalance accumulates over months or years, constant tension can develop in the erector spinae and muscles around the pelvis on the same side, and the way the leg muscles are used can change. As a result, we commonly see in clinical practice a chain of tension running through the thigh, shin, calf, ankle, and sole, or more weight being placed on one foot.

This doesn't mean it is the single cause that applies to every plantar fasciitis patient. Clinically, however, posture and weight distribution need to be examined when looking for why one foot is repeatedly overloaded.

Why calf tension and gait patterns should be checked together

Excessive tension in the calf muscles can affect ankle movement and gait patterns, so it should be checked along with sole pain.

When I see plantar fasciitis patients, I check tension in the calves and lower body, not just the sole. If two or more of the following occur on the same side, the balance of the whole body should be assessed:

• One side of the lower back often feels stiff
• The knee on the same side also hurts
• The shin feels tight
• The calf often knots up
• You get leg cramps at night
• Only one heel or sole hurts repeatedly

In these cases, rather than treating each as a separate symptom, it's important to check whether they are connected manifestations of a single weight-bearing pattern.

Five key factors we check during an exam

In evaluating plantar fasciitis, we look at five factors beyond the sole itself: left-right weight distribution, erector spinae tension, pelvic and leg muscles, walking habits, and foot structure.

In general, many factors can contribute to plantar fasciitis, including activity level, foot shape, gait, body weight, footwear, and repetitive impact. Treatment aimed only at the sole is therefore sometimes not enough. During an exam, we check the following five things:

1. Left-right weight distribution: We check which buttock you put more weight on when sitting.

2. Left-right erector spinae tension: We check whether the erector muscles on one side are constantly tense from the lower back up to the neck.

3. Pelvic and leg muscle tension: We look at which side of the thigh, shin, and calf is tenser.

4. Weight shift when standing and walking: We check which foot your weight stays on longer.

5. Structural problems of the foot itself: We also check for flat feet, high arches, foot deformities, and footwear issues.

The goal of treatment is preventing recurrence, not just relieving pain

When pain is severe, medication, physical therapy, or injections may be considered, but the ultimate goal of treatment is to find the cause of repeatedly favoring one side and correct posture.

When pain is severe, several approaches may be considered depending on the patient's condition, such as medication, physical therapy, and injection treatment. When excessive nerve and muscle tension is observed in specific areas around the spine, cases have been reported in which leg muscle tension and pain eased within one to two weeks after appropriate nerve block treatment. However, the injection itself is not the end goal. I believe finding out why the patient keeps putting weight on a particular foot and improving that posture is key to reducing recurrence.

Posture education is the key to preventing recurrence

The final stage of pain treatment is posture education, and changing long-standing habits usually takes several weeks to months of consistent effort.

A body that has been used incorrectly for a long time won't have its daily habits changed instantly by a few sessions in the treatment room. That's why we explain the following according to each patient's condition:

• How to distribute weight evenly between left and right when sitting
• How to reduce the habit of leaning the upper body forward
• How to avoid leaning on one leg when standing
• Exercises to restore front-back spinal balance
• How to make use of walking and running

Ultimately, patients need to understand their own posture and be able to correct it, and this kind of habit correction usually takes several weeks to months.

When other conditions need to be ruled out

Not all heel and sole pain is plantar fasciitis, so if the pain suddenly gets worse, an accurate diagnosis should come first.

Achilles tendon disorders, nerve compression, fractures, and joint conditions can also cause foot and heel pain. If severe pain comes on suddenly within a few hours, the foot becomes swollen and red, you can't bear weight after an injury, or you have reduced sensation, an accurate diagnosis should take priority over self-care.

Comparing treatments: self-care, physical therapy, and nerve block treatment

Plantar fasciitis management options differ in purpose, time to effect, and who they suit best, so it's important to choose based on the patient's condition.

These approaches aren't mutually exclusive and are often combined depending on the patient's condition. For exact costs of items not covered by insurance, it's best to check during a consultation.

Self-care you can do at home

Self-care with a massage ball or foam roller is not a treatment that eliminates the root cause of pain, but a supportive way to reduce recurring tension and prevent recurrence.

Everyday care is as important as treatment. Along with correcting posture and weight-bearing habits in the clinic, here are methods that can help when practiced consistently at home.

1. Releasing the plantar fascia with a massage ball (tennis ball)

• Place a tennis ball or massage ball on the floor, press gently with the sole of your foot, and roll it back and forth.
• Roll evenly from the heel to the ball of the foot under the toes.
• When you find a sore spot, press gently for about 10–15 seconds, then roll again, and repeat.
• Do this for 5–10 minutes a day on both feet, at an intensity that doesn't cause much pain.

If the foot is acutely and severely swollen or the pain is very intense, we recommend seeing a doctor first rather than pressing hard.

2. Releasing the calf muscles with a foam roller

• Place a foam roller on the floor, rest your calf on it, and slowly roll back and forth while supporting your body with your hands.
• Alternate between the inner, outer, and middle parts of the calf.
• At spots that feel knotted or tender, pause and press gently.
• Spend 1–2 minutes per side, alternating left and right.

If you habitually put more weight on one leg, the calf on that side is often tighter, so comparing the two sides can also be helpful.

Consistent care and an accurate diagnosis go hand in hand

Self-care can help prevent recurrence, but if pain lasts more than four weeks, you should see a doctor to identify the cause.

These self-care methods are closer to a supportive way of reducing recurring tension and preventing recurrence than a treatment that eliminates the root cause of pain. If you stand or walk a lot, doing them consistently at the end of the day, even briefly, can help. However, if the pain has already progressed considerably or keeps recurring for more than four weeks, self-care alone may have limits, and you need an exam that also looks into why a particular area is repeatedly overloaded.

Integrated care at Seoul Cheongdam Dr. Anapa Clinic

Beyond pain treatment, we run a combined care system that also covers problem nails, skin concerns, and more.

At Seoul Cheongdam Dr. Anapa Clinic (a clinic focused on pain medicine, dermatology, and rehabilitation medicine), experienced physicians provide one-on-one, personalized care to assess each patient's posture and weight distribution. We also treat problem nails such as ingrown toenails and toenail fungus with accurate, prompt diagnosis. For drooping eyelids or fine lines around the eyes, we offer the Iron Lifting Laser, which naturally improves eye-area firmness and fine lines without surgery, and for enlarged pores, we run an Iron pore laser program that smooths the skin over 3–5 sessions spaced two weeks apart.

Frequently Asked Questions (FAQ)

Q. If it hurts especially with my first steps in the morning, is that plantar fasciitis?

That is one of the typical symptoms commonly seen in plantar fasciitis. However, other heel conditions can cause similar symptoms, so if the pain keeps recurring, it's best to have an exam to identify the exact cause.

Q. Is frequent calf tightness related to plantar fasciitis?

The load on the ankle and foot is related to the movement of the calf and the entire leg. That's why the calf and gait pattern should also be examined during treatment.

Q. Why does only one foot keep hurting?

Many factors can be involved, including not only the structure of the foot but also walking habits, pelvic alignment, and left-right weight-bearing habits. It's especially important to first check whether you have daily habits of putting weight on one side.

Q. Once the pain goes away, is treatment over?

Reduced pain doesn't mean your existing posture and weight-bearing habits have been corrected. If the pain keeps coming back, it's important to also correct the lifestyle habits and posture behind it.

Q. I stand for long hours at work. Is there anything I should pay special attention to in preventing plantar fasciitis?

When you stand for long hours, repetitive load can easily build up in the feet and calves. In that case, it can help to shift your weight evenly between both sides throughout the workday and do 5–10 minutes of gentle self-release for the soles and calves each day. If the pain persists, it's best to have an exam to identify the cause.

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※ This article provides general health information. Treatment results may vary depending on individual health conditions, so be sure to consult a specialist.