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Achilles tendon pain affects your gait and increases your risk of injury during running and sports. If left untreated, overuse injuries to the Achilles tendon can lead to irreversible damage that undermines performance and leads to further injury. At NYDNRehab, our treatment toolbox includes ESWT (shockwave therapy), ultrasound-guided dry needling, Kineo Intelligent Load system, eccentric loading, plyometric exercises and retraining with real-time contextual feedback. Contact us today to eliminate Achilles pain and restore full function to your foot and ankle, so you can get back to the game of life.
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Studies show that there are no inflammatory cells present in patients experiencing pain in the Achilles tendon. Therefore this condition should properly be named Achilles tendinopathy. The word tendinopathy means that there is a degeneration of the tenocytes (tendon cells) in the Achilles tendon.
Non-insertional: Small tears in the middle fibers of your Achilles tendon begin to break down
Insertional: Damage occurs where your Achilles tendon meets your heel bone
Also called the calcaneal tendon
Shared by the gastrocnemius and soleus muscles of the calf
Connects the calf muscles to the heel bone
Releases elastic energy during running and jumping
In addition to reviewing your medical history and conducting a clinical exam, we use high resolution diagnostic ultrasonography to assess the injured area. Ultrasound imaging lets us view the damaged tissues in real time, with the injured area in motion. The patient becomes an essential participant in the diagnostic process, repositioning the foot and ankle as needed, and providing verbal feedback. Ultrasonography gives us real-time results, so we can begin treatment as quickly as possible.
According to research, young physically active people respond more quickly to treatment than middle-aged or older adults. For younger patients, treatment takes about 3 months. Rehabilitation is typically double that for older patients.
Aplio i800 ultrasound
Dr. Kalika uses high resolution diagnostic ultrasonography and sonoelastography to accurately diagnose Achilles tendinopathy. He then uses advanced treatment methods, including extracorporeal shock wave therapy (ESWT) and electromechanical transduction therapy (EMTT), to evoke a regenerative reaction at the cellular level.
We use innovative treatments and therapies based on scientific evidence and clinical results
NYDNRehab takes a holistic approach to treatment, combining the best treatment options based on the individual patient and the specifics of their injury.
Laser and Iontophoresis, ultrasound, steroid injections, plasma injections – all have very low to no scientific evidence.
Dr.Kalika has revolutionized Achilles tendon care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with gait and motion analysis technology. The NYDNRehab motion and gait analysis lab is the only private lab in the US to feature research-grade technologies found only in the world’s top research labs, and made available to patients in our private clinic. Dr.Kalika’s modern approach to athletic Achilles tendon injuries has put him on the radar of some of the world’s top distance runners, pro athletes and professional ballet dancers.
HyunJu
YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar
DC
Dr. Michelle Agyakwah
DC
Mariam Kodsy
Physical Therapist
Clinical director & DC RMSK
At NYDNRehab, we have extensive experience treating Achilles tendinopathy in runners, athletes and non-athletes. Treatment options vary, depending on the type and stage of Achilles tendinopathy. There are multiple structures surrounding the Achilles tendon, and Achilles problems can have different pathological origins, depending on the structures involved. Because of this, treatment for Achilles tendon pain should be individualized, based on precise diagnostics. At NYDNRehab we use sonographic imaging, sonoelastography and running gait analysis to create personalized treatment plans specific to the needs of each patient. Treatment may include: manual therapy, eccentric muscle loading, ESWT (shock wave therapy), EMTT (electromagnetic transduction therapy), ultrasound guided regenerative injections, force production exercises and Kineo intelligent loading exercises. Research has shown that a combination of ESWT and eccentric loading provide the best results for treating Achilles tendinopathy.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
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
