Foot, Ankle and Heel Pain

About Foot and Ankle Pain

Foot, heel and ankle pain can cause serious health problems, since your feet provide the foundation for all physical activity via connection to the ground. Foot pain can cause postural and structural problems throughout your body, and also affect all other joints and muscles in the rest of your body.

Dr. Lev Kalika

Clinical director & DC RMSK

About Heel Pain and Functional Podiatry Specialist Dr. Lev Kalika

Dr. Kalika, clinical director of NYDNRehab, has dedicated his life’s work to revolutionizing the way pain syndromes and movement disorders are diagnosed and treated. He was among the first in his field to embrace technology as a game-changer for patient diagnosis and treatment. The NYDNRehab clinic is one of the best-equipped physical therapy clinics in the world.
Dr. Kalika is an expert in holistic podiatry, an integrated functional approach to foot health that does not involve steroid injections or surgery. His approach entails advanced diagnostics, including:

high resolution ultrasonography
weight-bearing x-ray
3D Gait Analysis
foot pressure analysis

Treatment focuses on holistic foot function in the context of the entire lower kinetic chain. We combine the most advanced regenerative treatment methods with sophisticated foot and ankle physical therapy. Your treatment plan may include a prescription for orthotics and shoe modification strategies.

Dr. Kalika is certified in biomechanics and gait analysis, and is an expert in diagnostic ultrasonography. He has over 15 years of experience in successful treatment of foot and ankle conditions.

Dr. Kalika’s expertise is sought after by elite athletes, professional ballet dancers and runners, as well as physically active youth and adults in NYC. NYDNRehab is the premier clinic for heel pain in Midtown NYC.

Why Physical Therapy Alone May Not Resolve Your Condition

Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.

Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.

Issues that should be addressed prior to beginning physical therapy 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

Holistic Non-Invasive Diagnosis and Regenerative Therapy

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

At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy.

Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.

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

Why Treatment at NYDNRehab is Better than Conventional Foot and Ankle Physical Therapy

In recent years elective foot and ankle joint surgeries have become commonplace, but due to the complex structure of the feet and ankles, ankle joint replacement surgery has less optimistic outcomes than hip or knee surgeries.

The specialists at NYDNRehab believe that surgery should be the absolute last resort. We use the most advanced motion and gait analysis technology and the highest resolution musculoskeletal ultrasonography found in any private clinic in the USA. Dr. Kalika has spent many years developing his unique diagnostic approach that combines:

Diagnostic musculoskeletal ultrasonography
Integrative gait and motion analysis
Biomechanical analysis
Specialized gait physical therapy
Ultrasound guided procedures
Extracorporeal shockwave therapy (ESWT)
Extracorporeal Magnetotransduction therapy (EMTT)

NYDNRehab offers the most technologically advanced and comprehensive approach to foot and ankle treatment and rehabilitation in New York City. We believe that successful outcomes in musculoskeletal medicine can only be achieved via thorough examination using objective tools. It is our philosophy that what cannot be measured cannot be successfully treated.

Foot and Ankle Conditions We Treat

Ankle sprains

Arch pain

Chronic Ankle instability

Tibialis posterior tendonitis

Peroneal tendonitis

Achilles tendinitis

Heel pain and plantar fasciitis

Foot and ankle stress fractures

Shin splints and tibial stress
syndrome

Metatarsalgia

Morton’s neuroma

Halux valgus

Halux limitus

Plantar plate tears

Flat and overpronated feet

Sesamoiditis

Pinched foot nerves

Tarsal tunnel syndrome

Symptoms, Causes and Risk Factors of Foot and Ankle Conditions

Symptoms

Deformities of the bones and joints
Instability or a feeling that your ankle is collapsing
Soreness and tenderness of the fascia or soft tissues
Numbness and tingling sensations (paresthesia)
Stiffness or reduced motion in the foot, ankle or toes
Swelling and redness

Causes

Overuse from sports, running or exercise
Trauma from sports or accidents
High heels or unsupportive footwear
Standing for long hours on concrete
Old injuries that were never rehabbed
Faulty gait mechanics

Risk Factors

Obesity and sedentary lifestyle
Advanced age
Working in construction
Smoking
Participating in sports
Diabetes and osteoarthritis

Accurate Diagnosis Means Successful Treatment

Most common foot conditions can be diagnosed with clinical history and examination. In some cases, X-ray, MRI or diagnostic ultrasonography may be required.

At NYDNRehab, our specialists use diagnostic ultrasonography to visualize tendons, ligaments, bursa, muscles and the plantar fascia of the foot. We also use sophisticated video gait analysis technology to visualize and measure: forces acting on the foot, shock absorption, foot mechanics and mechanics of the entire lower kinetic chain.

Real time diagnostic ultrasound imaging
Fully integrated computerized gait and running analysis
Computerized ankle stability testing with C.A.R.E.N (computer assisted rehabilitation environment)
Postural stability testing
Computerized muscle force and strength testing

Accurate Diagnosis Means Successful Treatment

We Use High-Tech Equipment for Optimal Results

NYDNRehab’s movement analysis and retraining lab features some of the world’s most advanced research-grade technologies, rarely found in private clinics. Technologies recently added to our treatment toolbox include electromagnetic transduction therapy (EMTT) and blood flow restriction training (BFRT). We are always looking for new technologies and treatment approaches, to offer our patients the very best solutions to their musculoskeletal pain and dysfunction.

Our approaches to foot and ankle treatment include

3D Gait Analysis and Retraining

Mechanical errors in walking and running gait can cause foot and ankle pain. Our quantitative 3D analysis looks at joint kinematics, muscle activation patterns, weight distribution, ground reaction forces and more, to collate a comprehensive overview of your gait mechanics. Using hard data from our findings, we are able to retrain your gait with measurable results.

Load management

Traditional treatment for Achilles tendinopathy focuses on rest and stretching exercises, but current research indicates that tendons heal and regain function more quickly when treated with progressive weight loading therapy.

Eccentric strengthening

Current research suggests that eccentric tendon loading, where the muscle is lengthening, is the most effective treatment for relieving pain and restoring Achilles tendon function.

Blood Flow Restriction Training

BFR makes it possible to strengthen and rehabilitate injured tissues using much lighter loads than conventional resistance training. BFR helps prevent tissue atrophy after an injury while protecting damaged structures. It speeds the recovery process, for faster return to pain-free activity.

C.A.R.E.N
(Computer Assisted Rehabilitation Environment)

C.A.R.E.N immerses patients in a virtual reality environment while their motion is captured by 12 infrared cameras that provide 360º real-time feedback. Used for both diagnosis and treatment, C.A.R.E.N provides precise therapeutic strategies based on muscle activation patterns, eliminating human error.

Biofeedback Motor Control Training

This groundbreaking approach for patients with lower extremity pain and dysfunction uses force plate technology to measure the direction and magnitude of ground reaction forces during movement. Muscle activity in the area of injury is carefully evaluated, and adjustments are then made to improve function and eliminate errors in movement.

Our innovative specialized approaches for testing and retraining include:

Dynamic neuromuscular stabilization (DNS)
Kineo intelligent loading for AI muscle testing and retraining
Proteus motion 3D collinear resistance
Force plate jumping and rate of force development analysis and retraining
SEBT (star excursion banner testing) state-of-the-art motion and kinematic analysis of postural stability and retraining
Myolux ankle stability and proprioception testing and retraining device
AIM (anatomy in motion)
FMS (functional movement systems)
ISM (integrated system model)
Contextual rehab

Regenerative Technologies for Foot and
Ankle Physical Therapy

At NYDNRehab, we use a combination of treatment approaches for foot and ankle pain, based on the specific needs of the individual patient.
The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.
We combine regenerative shock wave therapy with electromagnetic transduction therapy and other regenerative approaches to relieve pain and stimulate healing. This proprietary technology is based on a unique set of pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process.
These non-invasive outpatient procedures represent breakthrough treatment options for pelvic pain and dysfunction.

Focused Shockwave Therapy

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.

Electromagnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.

High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.

HIGH ENERGY INDUCTIVE THERAPY (HEIT)

INDIBA CT9 Radiofrequency Device

Our INDIBA Tecar therapy machine converts electrical current into a stable radio frequency current of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing. INDIBA can be used to successfully treat joint and muscle disorders, low-back pain, sports injuries, surgical incisions and various pain syndromes. Another therapeutic effect of INDIBA is extreme and prolonged cellular hyperthermia. Due to this effect, INDIBA therapy combined with manual therapy and soft tissue tissue manipulation enables instantaneous release to occur, significantly shortening the number and duration of physical therapy sessions. What is normally accomplished in two months of physical therapy can be accomplished in 3-4 sessions with INDIBA.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to lower back pain. Dry needling is an outpatient procedure that inserts non-medicated needles into the trigger point to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Ultrasound Guided Injection
Therapies

Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, 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. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.

Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution, often containing dextrose, saline or lidocaine. The solution irritates the affected connective tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new normal ligament or tendon fibers.

Preventing Foot and Ankle Pain

If you are physically active in sports, dance or exercise, your risks of foot and ankle injuries are higher than average. Wearing supportive footwear, giving your body adequate recovery time, and fine-tuning your motor mechanics can reduce your risk.

Occupations that require you to spend long hours on your feet, such as restaurant work, retail, and industrial work, require supportive and protective footwear appropriate for your occupation. Elevating tired feet and soaking them in Epsom salts at the end of a long day can help reduce the risk of overuse syndromes like plantar fasciitis.

A thorough gait analysis can help you identify and correct inefficient gait patterns that can contribute to foot and ankle pain.

Get Personalized Foot and Ankle Physical Therapy, Designed Just for You

NYDNRehab’s approach to foot and ankle treatment combines manual foot manipulation, foot-specific myofascial release, lower kinetic chain exercises, acupuncture and ESWT. Our non-invasive conservative approach is superior to steroid injections and corrective orthotics because we treat the underlying cause of the condition, not just its symptoms.

Our treatment approaches are both integrative and functional. Rather than using orthotics to change the way your foot makes contact with the ground, we correct your walking gait to restore function, making your foot adaptable to the ground once again, and to the forces associated with walking and running.

Our treatment is based on the diagnostic results of sophisticated personalized gait analysis. We never use a one-size-fits-all approach to patient care. We understand that every patient has a unique anatomy, and that each condition has unique characteristics. We tailor our treatment plans to the individual, with one-on-one physical therapy that really works!

Clinical Case Studies
NYDNRehab

Case Study: Demystifying Persistent Ankle Pain

Our patient is a 44 year-old female complaining of ankle pain. She had sprained the ankle two years prior and had been successfully treated with physical therapy.

learn more

Get the Best Foot and Ankle Physical Therapy in
NYC

NYDNRehab is the top rated physical therapy clinic for foot and ankle pain in NYC. Schedule a consultation today, and see why the specialists at NYDNRehab are the best foot and ankle doctors in NYC.