Plantar Fasciitis Pain


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Plantar Fasciitis Symptoms and Causes

Proper treatment for plantar fasciitis begins with understanding where it came from and how the patient acquired it. Because the heel is such a pivotal and vulnerable part of the body, plantar fasciitis has a variety of different causes.

Because the plantar fascia is like a rubber band, loosening and contracting as the body moves, plantar fasciitis may occur from an excess of exercise or other strenuous physical activity. This is why athletes and runners are so susceptible to it. Excessive running or jumping places pressure on the foot’s soft tissues that can lead to tears and inflammation. Athletes who suddenly increase the difficulty of their exercise routines may also damage their feet because the body has not adjusted to the pressure suddenly being inflicted on it.

Plantar fasciitis may also result from prolonged exposure to shoes that don’t fit properly or fail to support the weight of the body. Walking or running in these shoes may create an imbalance of weight distribution in which one foot is doing more of the heavy lifting than another, thereby placing huge amounts of force on the ligament of the plantar fascia. Wearing high-heeled shoes or boots may lead to plantar fasciitis over time. Having an abnormal gait or posture may cause the tissues to stretch abnormally, resulting in tears and inflammation.

Plantar fasciitis may also be caused by certain kinds of arthritis that inflame the tendons. This is often the case among elderly patients, who are also more prone to diabetes which can further contribute to damage and heal pain. Overweight and pregnant women are also vulnerable for the same reasons. Hormonal changes that occur during pregnancy may cause ligaments to become more pliable, putting women at risk for plantar fasciitis.

The pain of plantar fasciitis is typically caused by collagen degeneration at the origin of the plantar fascia, in the calcaneus, because of tears in the plantar fascia that overwhelm the body’s self-repair mechanisms. Patients undergoing treatment of plantar fasciitis will often complain of a burning or stabbing in the foot that’s especially prominent when they awaken in the morning. The fascia ligament tightens at night when the body is at rest, lessening pain, but when we get out of bed it becomes taut and sends pain shooting throughout the body. The pain usually lessens as the tissue re-adjusts, but the condition may worsen with prolonged physical activity, including sitting or standing.

Plantar fasciitis symptoms and causes Causes and symptoms of heel pain

Plantar Fasciitis Pain Treatment NYC

What is the best treatment for plantar fasciitis? It really depends on the needs of the patient. In the majority of cases even chronic plantar fasciitis can be treated non-surgically through a combination of physical therapy and conventional methods such as orthotic inserts and extra-corporeal shockwave therapy (ESWT).

ESWT (extra corporeal shock wave therapy) is recognized by over a hundred scientific research trials as the most effective treatment for plantar fasciitis.

Follow this link to see a demonstration of ESWT’s immediate effectiveness.

At NYDNRehab we apply the most effective combination of radial and focused shockwaves, using the only Duolith Stortz device available in NYC. We have been performing shockwave therapy for 14 years, with thousands of successful outcomes.

Get to the bottom of heel pain

Some of the best-known plantar fasciitis exercises include plantar fascia stretching, calf stretching, and ice massages. Because the first steps getting out of bed in the morning may be the most painful steps of the entire day, one very effective way of breaking the cycle of pain and inflammation is through morning calf stretches. Before getting out of bed, take a belt and curl it around the ball of your foot. Then, keeping your leg straight, gently pull the belt and ball towards your body until you feel a gentle stretch in the lower part of your leg. Hold for thirty seconds and repeat up to five times before taking your first step into the morning.

The standing calf stretch, another physician-approved plantar fasciitis exercise, may be undertaken any time during the day. The patient faces and places his or her hands against a wall at eye level. Then, placing the injured leg behind him and the un-injured leg in front, with the heel of the injured leg resting on the floor, he makes a slight eversion (inward turn of the foot) and slowly leans into the wall until the back of the calf stretches slightly. Hold for 15 to 30 seconds, repeat three times a session, and perform as many sessions throughout the day as needed.

As simple as it sounds, self-massage is a proven and effective treatment for plantar fasciitis. The patient may massage his or her foot by placing a tennis ball or bottle of frozen water on the ground and gently rolling it under the foot for several minutes at a time. Using a tennis ball will help loosen the plantar fascia and make it less likely to be become irritated, while using a frozen water battle will help to keep inflammation at bay. It’s normal to feel some soreness when massaging the foot, but stop if you begin to feel any pain and consult with your doctor.

In addition to these, a doctor may recommend the insertion of an orthotic, a shoe insert custom-made for the patient, in order to stabilize the foot. Elevating the foot by means of an orthotic prevents tearing and lengthening of the plantar fascia, thereby relieving inflammation, while also preventing excessive pronation and correcting gait imbalances. Because short strides create excessive up-and-down motion in the body that places undue pressure on the muscles, tendon, and plantar fascia, orthotics are especially helpful for slow runners who have injured themselves through tearing of the plantar fascia caused by asymmetrical running.

Treatment of plantar fasciitis with latest tech

Orthotics lessen suffering in the overwhelming majority of plantar fasciitis patients. However, if even this proves ineffective, a cortisone injection may decrease inflammation. This is not recommended for all patients, as cortisone injections have been known to cause a worsening of heel pain symptoms in a small percentage of patients. In rare cases a physician may recommend a new, safe, non-invasive therapy known as extra-corporeal shock wave therapy, in which energy pulses are used to induce micro-trauma in the plantar fascia tissue that causes the body to repair those tissues. ESWT is recommended as an alternative for patients suffering from chronic plantar fasciitis for whom all the previous treatments have proven ineffective, and who are considering surgery to remedy the symptoms and rel

How do we treat Plantar Fasciitis?

The good news is that for those staggering under the weight of chronic plantar fasciitis, the New York DNR has a variety of treatment options available. We utilize diagnostic ultrasound to visualize the soft tissue around the calcaneus where most damage is inflicted. Our physical therapists assess the primary and contributing factors of heel pain to determine the origin of the condition and the best treatment for plantar fasciitis. We then provide an advanced heel therapy that mobilizes the joints of the foot and stretches the fibrous tissues, restoring them to their original function of supporting the foot’s weight.

Our safe, state-of-the-art, non-invasive and comprehensive method utilizes diagnostic technological GAIT and running analysis to diagnose biomechanical faults during running, and tissue pathology in the foot. Our special rehabilitative exercises strengthen and elongate muscles of the whole kinetic chain (hips, feet, and pelvis).

Our Computer Assisted Rehabilitation Environment (C.A.R.E.N), treats and re-stabilizes the patient’s locomotion, and running, posture, balance, re-training the nervous system in symmetrical weight-bearing and lessening the damage caused by excessive forces and excessive loading .If the integrity of the tendons or muscle tissues is compromised, we combine rehabilitation with biological regenerative treatment, making use of extra-corporeal shockwave therapy (ESWT) to regenerate damaged tendons and muscles.

See also: Sonoelastographic evaluation of plantar fascia after shock wave therapy for recalcitrant plantar fasciitis: A 12-month longitudinal follow-up study

Treatment of Plantar Fasciitis in NYC

If you are actively involved in athletics, dance, martial arts or fitness, you have an appreciation of the important role played by the “core” muscles of your trunk in providing pelvic and low back stability and mediating load transfer between your upper and lower body. In a very similar way, the core muscles of your feet provide stability and facilitate motion of the medial longitudinal arch (MLA) that compresses and recoils during running.
Your intrinsic foot muscles (IFM) play a key role in postural control and balance by controlling the height of the MLA and regulating your foot’s degree of pronation. During running, the IFMs act in parallel to the plantar fascia, lengthening during shock absorption and shortening as the arch recoils during propulsion, contributing to force production. If your IFMs are weak, your risk of injury may increase, predisposing you to conditions such as plantar fasciitis, Achilles and posterior tibialis tendinopathy, metatarsalgia and medial tibial stress syndrome. Weak IFMs can reduce arch height and lead to uncontrolled foot pronation, which may contribute to athletic injuries.
Just like any other muscles in your body, your IFMs can be made bigger and stronger, improving their ability to provide balance and support of the MLA. Two approaches to strengthening the foot core include “short foot” exercises, and isolated neuromuscular electrical stimulation of the IFMs. Foot core strengthening may benefit athletes whose feet tend to over-pronate by reducing their risk of injury. It may also be beneficial in the rehabilitation of patients with lower limb injuries whose IFMs have experienced detraining.
Diagnosis and treatment of plantar fasciitis in NYC

Unique Plantar Fasciitis Physical Therapy Treatment Approaches at NYDNRehab

Heel pain treatment
Best plantar fasciitis treatment in Manhattan
Computer assisted rehabilitation environment
Lev Kalika Clinical Director and DC, RMSK

Dr. Kalika is an internationally recognized plantar fasciitis specialist. He was the first heel pain doctor in NYC to pioneer comprehensive gait analysis and computerized foot retraining, using unique motion and gait analysis technology. His regenerative treatment combines focused, non-focused and radial shockwave with electromagnetic transduction therapy (EMTT) and ultrasound guided injections. He has published numerous scientific articles on the subject of diagnostic ultrasonography, ultrasound guided dry needling and comprehensive tech-based rehab.

Our Specialists

HyunJu YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar DC
Dr. Michelle Agyakwah DC
Mariam Kodsy Physical Therapist

Research at NYDNRehab

Kalika L., Bubnov R. ROLE OF FUNCTIONAL ULTRASOUND TO DETECT POINTS OF NERVE FIXATIONS: SUPRATARSAL TIBIAL NERVE TENSION SYNDROME IN MEDIAL HEEL PAIN. The 22nd European Congress of Physical and Rehabilitation Medicine (ESPRM 2020) in Belgrade, Serbia, 19th to 23rd September 2020. Abstract book: 581.
R. Bubnov, L. Kalika Multilevel evaluation of motion and posture patterns in lower extremity and spine using dynamic ultrasound. J Int Soc Phys Rehabil Med 2018;1, Suppl S1:1792.;year=2018;volume=1;issue=1;spage=103;epage=557;aulast=#ISPR8-1792


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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