Taeseok Ahn, Daeook Lee, Jihyun Moon, Jiwoo Kim, Youngjo So, Hyeon-gyu Cho, Sangho Ji, Sangkwan Lee, Myungjin Oh, Cheol-Hyun Kim. J Pharmacopuncture 2025;28:248-54. https://doi.org/10.3831/KPI.2025.28.3.248

Introduction: Achilles tendinopathy is a common musculoskeletal condition that significantly impairs gait and overall mobility, ultimately reducing the quality of life. It is characterized by activity-induced pain, swelling, and functional limitations, and is often caused by repetitive microtrauma, increased mechanical load, or reduced vascular supply. Without appropriate treatment, abnormal gait patterns such as medial collapse may occur, leading to long-term biomechanical imbalances. Despite available conservative and surgical options, no clear consensus exists regarding optimal management, and many patients fail to respond adequately. These limitations highlight the need for novel pathophysiology-based therapeutic approaches.Case Presentation: A 49-year-old restaurant worker experienced chronic left heel pain for five years and was diagnosed with chronic Achilles tendinopathy accompanied by calcific tendinitis. Previous treatments, including nine triamcinolone-lidocaine injections and ten platelet-rich plasma sessions, resulted in minimal improvement, and surgical intervention was recommended. She received a total of 12 treatment sessions over a 47-day period. The patient underwent a four-stage ultrasound-guided acupuncture protocol. The protocol included the following: (1) management of paratenonitis, (2) fascial release between the gastrocnemius and soleus muscles using pharmacopuncture, (3) removal of neovascularization via high-volume injection, and (4) periosteal pecking technique (also called dry needling, and referred to as Golmak-Jaktak-beop in traditional Korean medicine) and high-frequency electroacupuncture targeting the Achilles tendon insertion. Post-treatment color Doppler ultrasonography showed reduced intratendinous neovascularization. The patient’s Foot and Ankle Outcome Score (FAOS) subscales demonstrated consistent improvement throughout treatment and at the two-month follow-up.Conclusion: This case suggests that a four-stage ultrasound-guided acupuncture approach may be a potential nonsurgical treatment option for chronic Achilles tendinopathy, especially in patients unresponsive to conventional therapies.

Jihyun Moon, Juhwan Song, Jiwoo Kim, Youngjo So, Hyeon-gyu Cho, Sangho Ji, Myungjin Oh, Sangkwan Lee, Taeseok Ahn, Cheol-Hyun Kim. J Pharmacopuncture 2025;28:154-63. https://doi.org/10.3831/KPI.2025.28.2.154

Post-stroke equinovarus foot (EVF) is a common and disabling complication of stroke, characterized by ankle plantarflexion and inversion due to muscle spasticity. It often results in abnormal gait patterns, increased risk of falls, and diminished quality of life. Although various interventions have been proposed, targeted and effective treatments remain limited. We report two patients with post-stroke EVF: a 54-year-old male 10 months after ischemic stroke, and a 37-year-old female 2 years after hemorrhagic stroke. Both exhibited spasticity of the gastrocnemius and tibialis posterior muscles, leading to asymmetrical gait and impaired mobility. Each patient underwent four sessions of ultrasound-guided acupotomy over two weeks, targeting the affected spastic muscles under real-time imaging. Quantitative gait analysis demonstrated significant improvements in the step length ratio (Case 1: 0.67 → 0.87; Case 2: 0.68 → 0.85). Secondary improvements were also observed in gait velocity, lateral symmetry, balance parameters, and Modified Ashworth Scale scores. No adverse events were reported during or after treatment. These cases suggest that ultrasound-guided acupotomy may serve as a precise and minimally invasive treatment for post-stroke EVF by selectively releasing spastic muscles while preserving surrounding structures. Further research is warranted to validate these findings in larger cohorts and through controlled study designs.

Background: Post-stroke equinovarus foot (EVF) impairs gait stability, increases the risk of secondary injuries, and contributes to elevated healthcare costs. However, effective targeted interventions for EVF remain limited. Patient concerns: Two patients with chronic EVF—a 63.5-year-old male (9.7 months post-stroke) and a 35.7-year-old female (24.5 months post-stroke)—presented with ankle deformity, gait asymmetry, and impaired balance, all of which interfered with daily activities. Intervention and outcomes: Both patients underwent ultrasound-guided acupotomy targeting spastic ankle muscles, administered over four sessions within two weeks. A quantitative gait analysis revealed substantial improvements in step length ratios (Case 1: 0.61 → 0.86; Case 2: 0.67 → 0.88), as well as enhancements in walking velocity, lateral symmetry, postural balance, and Modified Ashworth Scale scores. No adverse events were reported. Protocol proposal: Based on these observations, a prospective randomized controlled trial is planned to compare ultrasound-guided acupotomy plus conventional therapy versus conventional therapy alone. Outcomes will be assessed quantitatively using gait analysis. Lessons and implications: Ultrasound-guided acupotomy may offer a minimally invasive, targeted approach to releasing spastic muscles while preserving neurovascular structures, thereby improving gait function in patients with post-stroke EVF.