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Home Treatment Methods Shock Wave Therapy for Heel Pain and Plantar Fasciitis

Shockwave Therapy for Plantar Fasciitis

About Plantar Fasciitis

Plantar fasciitis is a painful condition affecting the tough elastic band of connective tissue running from heel to toe along the bottom of your foot. It arises when repetitive overuse, fatigue, and/or structural imbalances cause microtears, trigger points and densification of the plantar fascia, causing pain and reducing mobility.

For years, conventional treatment of plantar fasciitis has focused on stretching, steroids, and expensive orthotics that do little to relieve your pain. Today, modern technologies are revolutionizing the way plantar fasciitis is diagnosed and treated. When used in conjunction with other therapies, shockwave therapy for plantar fasciitis can help eliminate pain and regenerate your plantar fascia in just a few sessions.

As part of your foot arch complex, the plantar fascia stores elastic energy when stretched, much like a rubber band, releasing it as the fascia shortens to help propel you upward and forward – a property called the Windlass Mechanism.

Multiple studies using sonoelastography show that when irritated, the plantar fascia becomes overstretched and excessively lax. Micro tears appear, similar to the fraying of a rubber band after repetitive stretching, causing the fascia to lose the necessary stiffness to transmit elastic force.

Stretching exercises and orthotic devices typically used to treat plantar fasciitis rarely help to relieve symptoms – in fact, stretching exercises can actually make your condition worse. Corticosteroid injections are also often prescribed to relieve pain and reduce inflammation, but while steroids are known to provide short-term pain relief in 20-30% of patients, repeated injections can cause long-term damage to the plantar fascia, making plantar fasciitis a chronic condition.

In recent years, much research has emerged on fascial tissue, shedding new light on its properties, pathologies and the most effective therapies. NYDNRehab is at the cutting edge of plantar fasciitis treatment, thanks to our experience, our advanced technologies, and our personalized integrative approach to patient care.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Shockwave Therapy Specialist Dr. Lev Kalika

Dr. Kalika remains at the forefront of fascia research by pursuing continuing education on the most advanced approaches to fascial therapy. With certifications in Stecco fascial manipulation, ultrasound-guided dry needling, shockwave therapy, and other advanced methodologies, Dr. Kalika’s expertise in treating fascial pathologies like plantar fasciitis is unsurpassed in NYC.

In addition to years of training and experience in extracorporeal shockwave therapy (ESWT), Dr. Kalika is recognized as an international expert in musculoskeletal ultrasonography, and has published multiple scientific papers on its applications in rehabilitative medicine.

The clinic at NYDNRehab features the most advanced shockwave equipment available, enabling us to effectively target different types of tissues by adjusting the frequency, intensity, breadth and depth of tissue-specific shockwaves. Our use of ultrasound imaging to guide shockwave procedures ensures that the shockwaves hit their mark, to produce optimal results.

Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment (ISMST). His 20+ years of experience and expertise in ESWT and diagnostic ultrasound imaging make NYDNRehab the clinic of choice for extracorporeal shockwave therapy in NYC.

Accurate Diagnosis is Essential for Effective Treatment

Misdiagnosis of foot pain is common – in fact, 40% of patients with heel pain are misdiagnosed with plantar fasciitis when they actually have other conditions such as plantar or calcaneal nerve entrapment, tarsal tunnel syndrome, atrophy of the heel fat pad, calcaneal stress fractures, or bone spurs.

The high rate of misdiagnosis is due largely to the reductionist approach of modern medicine, where the body’s integrated systems are not taken into account. When diagnosis is based on symptoms alone without confirmation from high-resolution imaging, patients stand the risk of being undertreated or mistreated, prolonging their pain and dysfunction without resolving the underlying cause.

At NYDNRehab, we use high-resolution diagnostic ultrasonography to differentiate between various sources of heel pain that can mimic plantar fasciitis symptoms. Ultrasound ensures accurate diagnosis and appropriate treatment to resolve your heel pain. On-site diagnostic imaging on your first visit sets things in motion for fast and effective treatment.

Why Physical Therapy Alone is Not
Enough to Resolve Plantar Fasciitis

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your condition can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

Obstacles to physical therapy success include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

At NYDNRehab, we use a broad range of regenerative technologies and integrative therapeutic approaches to resolve issues that can stand in the way of successful physical therapy. Our staff is certified in a diverse array of holistic treatment methodologies, and our one-on-one treatment sessions are personalized, based on your unique diagnostic profile.

Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is an evidence-based approach to plantar fasciitis treatment. This advanced technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for regenerating plantar fascia tissue.

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health. SoftWave is the only unfocused shockwave technology currently available. According to recent research, SoftWave defocused waves combined with focused and radial shockwaves have maximum regenerative potential.

SoftWave Electro-Hydraulic Shockwave Therapy
Myofascial Acoustic Compression Therapy (MyACT)

Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment.

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties.The mechanical properties of EPAT make it especially effective for fascial manipulation in combination with focused shockwaves. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.

Extracorporeal Pulse Activation Technology (EPAT)

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, spun in a centrifuge to extract a high concentration of platelets. When injected into the plantar fascia, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels.

Interfascial Plane and Nerve Hydrodissection

When injured, the plantar fascia can become densified and lose its slippery and elastic properties, often entrapping nerves and blood vessels and preventing them from gliding. During the hydrodissection procedure, a saline solution is injected into densified fascia under ultrasound guidance. The solution works by separating fascial layers and freeing up entrapped nerves and blood vessels.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to musculoskeletal pain and dysfunction. The dry needling procedure inserts filament-thin non-medicated needles into trigger points to evoke a twitch response, relaxing contracted fibers and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing discomfort for the patient.

Extracorporeal Shockwave Therapy for Plantar Fasciitis

Extracorporeal shock wave therapy (ESWT) is a non-invasive regenerative treatment that applies focused high frequency sound waves to the affected tissues. Shockwaves generate new stem cells and activate them to repair the collagen fibers in your plantar fascia. Treatment is fast and painless, and many patients report significant pain relief after their first session.

To optimize effectiveness, we perform shockwave therapy under ultrasound guidance. High-resolution ultrasound imaging lets us visualize the plantar fascia in real time, helping to guide the shockwave procedure and ensuring we select the proper energy type and depth of penetration.

Shockwave therapy is an evidence-based approach for treating plantar fasciitis:

  • A recent research review of 11 randomized controlled trials, involving a total of 658 participants, found ESWT to be effective for reducing pain and improving foot function in patients with chronic plantar fasciitis. The researchers concluded that ESWT can be an effective alternative to traditional plantar fasciitis treatment methods
  • Another study found that just five ESWT sessions performed every-other day produced highly satisfactory results in trial participants, in terms of pain relief and improved foot function.

Compared to weeks or months wearing uncomfortable orthotics and taking harmful medications, ESWT delivers fast relief from plantar fasciitis symptoms in the course of several therapy sessions.

Plantar Fasciitis Symptoms, Causes and Risk Factors

Symptoms

  • Heel pain first thing in the morning – the main early sign of plantar fasciitis
  • Stabbing heel pain that worsens after rest
  • Pain and swelling around the heel
  • Pain that extends from the heel to the foot arch
  • Pain that intensifies when standing or walking
  • Increased heel pain as you wind down at the end of the day

Causes

  • Repetitive overuse from sports or exercise
  • Poorly fitting and/or non-supportive footwear
  • Weak intrinsic foot arch muscles
  • Faulty gait mechanics
  • Poor alignment of the lower kinetic chain
  • Tight calf muscles

Risk Factors

  • Being overweight or obese
  • Sedentary lifestyle
  • Type 2 diabetes
  • Wearing high heels
  • Occupations that require standing on hard surfaces

One-on-One Plantar Fasciitis Physical Therapy

Once we pre-treat your trigger points and densified fascia, we are ready to proceed with your customized plantar fascia physical therapy. Physical therapy for plantar fasciitis is aimed at correcting imbalances, mechanical errors and weaknesses that predispose you to plantar fasciitis.

Your physical therapy sessions may include:

  • Foot core training to strengthen the muscles that support and surround the plantar fascia
  • Walking and/or running gait analysis and retraining
  • Exercises to promote lower kinetic chain alignment
  • Stretching exercises for the calf muscles and Achilles tendon
Our physical therapy protocols are customized, based on your unique patient profile. Our personalized one-on-one approach ensures that you get the very best care, with the fastest possible results.

Preventing Plantar Fasciitis

Lifestyle factors play a huge role in preventing plantar fasciitis. You can begin to make simple and inexpensive lifestyle changes today that will protect you from plantar fasciitis in the future. Follow these guidelines to avoid plantar fasciitis:
  • If you are physically active, frequently replace worn athletic shoes
  • Do regular foot and ankle exercises
  • Frequently stretch your calves and Achilles tendons
  • Shop for comfortable work shoes that provide support and shock absorption
  • Avoid wearing high heels if you need to stand and/or walk for long periods
  • Soak achy feet in epsom salts before bed
  • Take frequent breaks from standing
  • Avoid standing and walking on concrete surfaces
  • Reduce and manage your body weight
  • Eliminate sugars, grains and starches from your diet that promote diabetes
  • Drink plenty of water to promote slippery and elastic fascia
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Get the Best Shockwave Therapy for Plantar Fasciitis in NYC

To be effective, shockwave therapy requires a skilled and experienced practitioner who understands the properties of various tissue types. Shockwave therapy for plantar fasciitis is most effective when guided by high-resolution ultrasound imaging, and used in conjunction with regenerative needling therapies, fascial manipulation therapy, and other advanced methods and procedures.

The advanced technologies at NYDNRehab are second to none in NYC. Conventional therapists rely on ineffective and outdated treatments for plantar fasciitis that provide slow and subpar results. For fast and effective plantar fasciitis therapy, contact NYDNRehab today, and start healing so you can get back to doing the things you love.

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Shockwave Therapy for Plantar Fasciitis FAQs

Is plantar fascia shockwave therapy painful?
During your shockwave therapy procedure, you may feel vibrations from the shockwaves. While some patients report discomfort, you are unlikely to experience any pain.
How do shockwaves help plantar fasciitis?
Connective tissues like the plantar fascia are generally avascular, meaning there is a limited supply of blood and nutrients available to promote healing. Shockwaves stimulate your body to generate new stem cells and activate them to repair the frayed collagen fibers in your plantar fascia and restore elasticity. Many patients report significant pain relief after a single session.
Will I still need my orthotics after shockwave therapy for plantar fasciitis?
Orthotics are designed to alter the angles at which your foot strikes the ground. Since they force your feet into “unnatural” angles, they can do more harm than good. After shockwave therapy for plantar fasciitis, foot core physical therapy can help to restore your foot’s natural function, without the need for orthotics.
Will shockwave therapy alone be enough to get rid of my heel pain?
While shockwave therapy for plantar fasciitis promotes healing, we combine it with foot core training to improve foot stability and function, to reduce force loads on the plantar fascia. Our goal is to completely eliminate plantar fasciitis symptoms and reduce their risk of recurring.
How long will it take for my foot pain to go away after shockwave therapy for plantar fasciitis?
Most patients report immediate pain relief after shockwave therapy for plantar fasciitis. When combined with Stecco therapy, dry needling and other treatment approaches, your plantar fasciitis symptoms should be completely gone after a few sessions.

Certificates and Postgraduate Education

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Physical therapy and rehab can be time consuming,
and a faulty diagnosis can make treatment a total waste of time.

Failure to accurately diagnose a condition in its early stages can lead to chronic
problems and sometimes devastating results

Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

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Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

Learn more »
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Accurate Diagnosis Is the ONLY way to
Successful Treatment
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A bad physical therapy experience is one of the primary causes of unnecessary surgery

At NYDNR, we believe in
medical innovation

We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.

  • С.A.R.E.N.
  • Kineo
  • Proteus shoulder arm recovery
  • Zebris
  • Manuthera 242
  • ESWT
  • Vertimax
  • Ankle Stabilizing Device
  • Blood Flow Restriction
С.A.R.E.N. С.A.R.E.N. Kineo Kineo
Proteus shoulder atm recovery Proteus shoulder atm recovery Zebris Zebris
Manuthera 242 Manuthera 242 ESWT ESWT
Vertimax Vertimax Ankle Stabilizing Device Ankle Stabilizing Device Blood Flow Restriction Blood Flow Restriction Training
  • Aplio i800
  • Vibration Platform
  • Sensa mat
  • Force Plate
  • Fascial Gun
  • ShooTools Slider
  • Redcord
  • Cryo Therapy
  • Skier's Edge
Aplio i800 Aplio i800 Vibration Platform Vibration Platform Sensa mat Sensa mat
Force Plate Force Plate Fascial Gun Fascial Gun ShooTools Slider ShooTools Slider
Redcord Redcord Cryo Therapy Cryo Therapy Skier's Edge Skier's Edge

Most importantly,

we are the only facility in the US

where structural medical diagnosis is reflected in functional treatment, and vice versa.

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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)

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Complete tear of rectus femoris
with large hematoma (blood)

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

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