BACKGROUND Synovial sarcoma (SS), a rare malignant soft tissue tumor whose histological origin is still unknown, often occurs in limbs in young people and is easily misdiagnosed. CASE SUMMARY We report a 24-year-old man who sought treatment for plantar pain thought to be caused by a foot injury that occurred 4 years prior. Currently, he had been seen at another hospital for a 1-wk history of unexplained pain in the left plantar region and was treated with acupuncture, a kind of therapy of Chinese medicine, which partly relieved the pain. Because of this, the final diagnosis of biphasic SS was made after two subsequent treatments by pathological evaluation after the last operation. SS is rarely seen in the plantar area, and his history of a left plantar injury confused the original diagnosis. CONCLUSION This study shows that pathological and imaging examinations may play a vital role in the early diagnosis and treatment of SS.