Chronic ankle pain from an untreated injury can cause serious health problems, since healthy feet and ankles are foundational to all physical activity. Ankle pain can cause mechanical issues throughout your body, and can also impact your cardiovascular and metabolic health due to reduced activity.

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Cronic ankle sprain that won’t go away

Forty percent of people who sprain an ankle will develop chronic ankle instability (CAI), which will later develop into ankle osteoarthritis, for which there is currently no successful solution. Ankle replacement surgery is much more complicated and much less effective than knee or hip replacement. Regenerative procedures are also much less promising for repair of ankle cartilage damage, compared to knee or hip cartilage.


What we can do:

  • Prevent ankle sprains
  • Rehabilitate even the most minor ankle sprains, because research shows that there is cartilage damage in minor ankle sprains that goes unnoticed early on
  • Thoroughly rehabilitate serious ankle sprains

There is a catch:

Before your undertreated ankle sprain begins to cause chronic ankle pain or turns into osteoarthritis, it will potentially destroy your hips, knees or low back without your awareness. Unfortunately, traditional medicine does not recognize the detrimental impact of ankle sprains on other body structures.

The problem is that doctors do not recognize problems associated with ankle sprains until it is too late, and many physios don’t know how to treat them, or have the right tools to do so.

Typical physical therapy treatment with a regular pt
will likely include:

Although these methods have some merit, they are only the tip of the iceberg.

Many neurological and orthopedic changes are taking place in an unstable ankle. In fact, ankle sprains could aptly be renamed “brainkle” sprains, because they involve the neuromuscular system. These changes are intertwined and can only be reversed if all are addressed. They include:

  • Loss of mobility in the fascia and foot joints
  • Reduced postural stability
  • Diminished proprioception
  • Reduced range of motion
  • Lower cutaneous sensitivity
  • Altered arthrokinematic and gait patterns
  • Development of multiple compensatory patterns
  • Reduced multisensory re-weighing
  • Loss of ankle and foot intrinsic muscle strength
  • Diminished muscle speed and power
  • Reduced proximal control
  • Loss of balance
  • Altered reflex responses
  • Research shows that patients who are unable to cope after an ankle sprain have all of the above-listed impairments, and that ankle stability can only be restored when all the changes are addressed

Typical physical therapy treatment with a regular pt
will likely include:

I am proud to say that our clinic at NYDNRehab is the top rehab clinic for chronic ankle sprain treatment in the country. Many professional athletes from the US and abroad come to us to rehab their ankles. We have developed a ground-breaking methodology and acquired research-grade technologies to address the impairments that cause ankle instability.

In addition to conventional physical therapy, we use the highest available resolution ultrasonography for dynamic ligament imaging and needle guidance. Other treatments include:


  • Ultrasound guided dry needling and extracorporeal shockwave therapy to deal with fibrotic (scar tissue) build up.
  • Ultrasound guided prolotherapy
  • 3D gait and running analysis


  • NEMS (neuromuscular electrical stimulation)
  • KINEO Intelligent Load technology
  • Blood flow restriction training


  • Highly specialized evidence-based motion analysis specific to ankle injuries. unavailable elsewhere
  • SEBT 3D kinematic analysis
  • C.A.R.E.N (Computer assisted rehabilitation environment) perturbation-based testing and real-time multisensory ankle feedback retraining


  • DLEST evidence-based lower extremity stability test
  • Integrative motion analysis (force plate, video and infrared motion capture), to assess hoping, jumping, cutting and other performance parameters
  • Myolux electronic ankle proprioception rehabilitation device


  • APOS instability shoe
  • Posturo/propriomed platform
  • TeleHealth physical therapy


Lev Kalika Clinical Director and DC, RMSK

Dr.Kalika revolutionized foot and ankle care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with with gait and motion analysis technology. Dr.Kalika’s motion and gait analysis lab is the only private lab in the US that features research-grade technology found only at top research universities, made available to patients in his private clinic.

Our Specialists

Dr. Mikhail Bernshteyn MD (Internist)
Dr. Michael Goynatsky DPT
Dr. Daniela Escudero DPT
Dr. Michelle Agyakwah DC
Dr. Tatyana Kapustina L. Ac.

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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