Foot ankle and heel pain treatment

About Foot ankle and heel pain

Foot, heel and ankle pain can cause serious health problems, since your feet provide the foundation for all physical activity. Foot pain can cause postural and structural problems throughout your body, and also affect your metabolic health, impacting your heart, circulatory system and blood sugar.

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Most conditions of the foot involve joints and soft tissues such as muscles, tendons and fascias. Therfore symptoms are usually dull, deep, and achy, with chronic conditions. Point tenderness and sharp pain is not uncommon if the condition is acute or if nerve tissue involved.


Foot and ankle pain is most frequently a result of a combination of factors which, structural predisposition and poor biomechanics are key players. Poor biomechanics and loss of more commonly dispersed throughout the lower kinetic chain from the pelvis to the foot.



Gait Analysis at NYDNR



Plantar fasciitis


Achilles tendinitis & tendinosis


Heel pain due to other causes


Mid and inner arch pain that may occur with:

– Peroneal tendinitis

– Tibialis posterior tendinitis and flat foot disorders

– Top arch pain


Ankle pain due to acute trauma or chronic overuse


Mortons neuroma


Big toe pain: halux limitus, 1st toe arthritis, halux valgus




Foot arthritis


Ankle pain due to acute trauma or chronic overuse


Ankle instability


Steroid injection


Prp ( plasma) injection




Nerve hydrodisection


Gait Laboratory

We believe that our approach, which is the combination of manual foot manipulation, foot specific myofascial release, lower kinetic chain exercises, acupuncture and ESWT (extracorporeal shockwave therapy) is superior to steroid injection and orthotic correction approaches. Our treatment is integrative as well as functional. We do not bring ground to the dysfunctional foot by fitting it into orthotics. Instead, we change the gait (walking) and function of the foot to the degree that the foot can once again become adaptable to the ground and forces associated with walking or running. Our treatment is individually based on sophisticated gait analysis diagnostic results.



This field of ultrasound guided dry needling is not based on the concepts of acupuncture . Acupuncture is performed by inserting needles superficially into body’s channels in order to harmonize energies in the body by stimulating body’s meridians Functional guided dry needling is predicated upon evidence-based Western medical knowledge and the rules of anatomy and physiology.The needles are inserted deeper based on anatomy visualization under ultrasound.


In 1997 Dr.Kalika personally learned dry needling from Karel Lewit ( the founder of dry needling method) himself when he moved to Prague.In 2006 Dr.Kalika became a member of ISMST (international society of medical shockwaves) further progressing his knowledge in treatment of myofascial pain by using extracorporeal shockwave technology.In 2014 Dr.Kalika became interested in ultrasound diagnosis of trigger points and conducted multiple studies in Europe delivering this method for the first time in NYC. At NYDNRehab we use very comprehensive approach by combining functional guided dry needling, extracorporeal shockwave therapy, neuromuscular manual therapy and ontogenetically based physical therapy approach for treatment of myofascial pain.

Flat foot correction

Flat feet are not a life sentence. Loss of your foot arch is one of the possible variations of the human foot shape. Unfortunately people with flat feet are prone to losing the foot’s ability to transition from pronation to neutral. Many champion long distance runners and marathon runners have flat feet, but when viewed in slow motion video, you will see that their flat feet have the ability to return to neutral position. I have been helping people recover function in their flat feet for the past 20 years.

Common Causes of Foot Pain and Discomfort

Painful, achy or itchy feet can make your life miserable, especially if you have to stand all day. While there are dozens of remedies on the market for foot pain, most only treat the symptoms without eliminating the cause.

Some common types of foot pain include

Athlete’s foot is a fungal skin infection, usually contracted in a warm moist environment like public showers, locker rooms and swimming pools. It can be painful, itchy and highly contagious.


Bunions are formed when your big toe is forced into a narrow space, causing a bony bump at the base of your big toe joint. Bunions are usually caused by too-tight shoes, high heels and excess body weight.


Diabetic neuropathy occurs when chronic high blood sugar damages the nerves in your feet, causing pain, tingling and numbness.


Ingrown toenails are caused by too-narrow shoes, or failing to properly trim your toenails. They can also be caused by running and other repetitive physical activity.


Plantar fasciitis is an inflammation or irritation of the plantar fascia, the tough band of connective tissue that connects your heel to your toes across the bottom of your foot. PF can cause pain in your heel and into the arch of your foot. It can be caused by repetitive motion, poor gait mechanics, long bouts of standing and unsupportive footwear.


Heel spurs are clusters of calcium that are outgrowths of bone. They irritate surrounding soft tissues, causing pain. Heel spurs may be caused by strain on muscles and ligaments from poor gait mechanics, ill-fitting shoes or excess body weight.


Stress fractures can occur from repetitive impact from running or jumping. They often occur in the metatarsal bones that run the length of the foot to your toes. Poor gait mechanics may be a contributing factor.


Lateral foot pain along the outer edge of your foot can be caused by a pinched nerve, peroneal tendinitis, stress fractures or other issues.


Foot pain can alter your gait as your brain sends signals for the body to compensate. Compensation patterns often remain, long after foot pain is resolved.

Gait analysis and retraining, Anatomy in Motion and Dynamic Neuromuscular Stabilization are just some of the treatment methods available that can help eliminate compensation patterns and reduce your risk of future pain and injury. Special exercises to train the intrinsic foot core muscles may also help alleviate foot pain.

Common Causes of Ankle Pain

Your ankles play a major role in stabilizing your body while standing, walking, running and playing sports. Ankle injuries can significantly alter your gait and undermine your body mechanics.

Some common causes of ankle pain include:

Sprains and strains occur when you “twist” your ankle, causing the foot to roll laterally. A strain does damage to muscle tissue, while a sprain stretches or tears ligaments. Ankle sprains should be treated with rehabilitative exercise.


Achilles tendinosis and Achilles tendon ruptures can cause extreme ankle pain and dysfunction. Tendon tissue is slow to heal due to limited vascularity. Achilles tendon issues can be rehabilitated with eccentric loading and extracorporeal shock wave therapy (ESWT).


Bone stress fractures are often overlooked during ankle pain diagnosis, and heel bone fractures are often mistaken for plantar fasciitis. Accurate diagnosis is critical for appropriate treatment and pain relief.


Osteoarthritis is a degenerative joint condition that can reduce ankle function and cause pain.


Tarsal tunnel syndrome arises from compression of the posterior tibial nerve, causing pain anywhere along its path, from the inside of the ankle to the foot.

Ankle pain should not go untreated, as it can cause mechanical issues throughout your body. Physical therapy that includes ankle stabilization exercises and gait retraining can be highly effective for eliminating pain and preventing further injury.



Foot, Ankle and Heel Pain Treatment

The human foot design is unique in the animal world. From the evolutionary standpoint human foot is a highly innovative anatomical structure that had developed to serve as the main weight receptor of the newly achieved bipedal support base. It evolved to be the most durable anatomical formation in the entire human body. Aside from the time of infancy when the body is horizontally aligned, the foots intricate structures provide, in conjunction with the ankle bones and powerful connective ligaments, the perfect biomechanical apparatus for ambulation or bipedal locomotion. The human foot however was not designed to be operated on high heels and used excessively on hard unyielding surfaces. Evolution knows no asphalt nor does it wear Prada. Outside of direct trauma, arthritis and conditions caused by structural misalignments, all foot/ankle problems are caused by what is generally termed overuse but should rather be called abuse. Today foot and ankle pain has become one of the most common musculoskeletal afflictions facing ever increasing number of people.

Computerized Image of Human's Foot When Stepping on Its Tip

Foot and Ankle Pain Treatment

Historically foot and ankle conditions had been treated without much regard to the structures higher up in the kinetic chain. The treatment was mostly palliative and passive. Doctors would inject steroids into the painful areas and prescribe orthotics in the hope to re-align different parts of the foot into more anatomically functional apparatus, all this with limited success.

In the past decade, due to technological advances, novel approaches regarding foot and ankle pain treatment has been established. We are now entering the era when new unorthodox yet scientific analytical methods of diagnostics are being developed. Unlike any static radiology tests, such as MRI, Ultrasound or X-ray, these new technologies generate dynamic picture giving us direct evidence as to where exactly the problem originates.

Conventional radiological modalities do reveal structural abnormalities in the tissues. The fact however is, that structures that look abnormal on the radiological images does not necessarily equate to pain. New technologies allow us to observe the anatomy of the foot and ankle in motion, giving us opportunity to pinpoint the origin of the problem at its core and address it there for the optimal effect. In all fairness, commonly used medical testing techniques can locate sensitive or painful tissues. But, as we know, in neuromuscular system most of the time pain is irradiated from other locations and therefore finding painful fibers is only a part of the puzzle. The doctor needs to have a broad view of the entire area in motion in order to be able to identify the pathology of the movement itself. With the new emerging technology the aberrant movement is diagnosed with precision allowing us to pinpoint the cause.

One such new technological advancement is Gait Lab. Gait Lab is a combination of high speed motion video cameras, surface electromyography with force plates or the pressure-registering treadmill and marker-capturing software. Gait Lab examination provides an extremely complex and sophisticated interpretation of all forces exerted and distributed during movement, such as gait or running.

This type of analysis can diagnose precisely the nature of the probe, which always has its origins in movement and not only provide clinician with complex computerized data set, but most importantly can suggest type of intervention. For example it can prove or disprove efficiency of orthotics as well as suggest proper exercise routine, monitorit and give patient feedback about his or her performance and progress in care. Unfortunately at this time this advanced technology is not widely available in clinical practice as it is in academic research. However it will not be long until this type of intervention is going to gain its due popularity.

At Dynamic Neuromuscular Rehabilitation we have been fortunate t o use Gait Lab equipment for treatment and diagnosis to the advantage of our patients.

We successfully integrate conventional clinical examination of the foot and ankle complex, such as Diagnostic Ultrasound, X-rays and Nerve Conduction studies, with the newest technology to reach the most precise diagnosis and implement the optimal intervention for people suffering from foot and ankle pain.

We are also proud to be among the first to use the AlterG gravity reduced treadmill for treatment of foot and ankle conditions.

We have one of the longest experiences with ESWT (Extracorporea Shockwave Therapy) for treatment of foot and ankle tendon-bone disorders, such as:

  • Plantar fasciitis
  • Heel pain
  • Achilles Tendon disorders

We are successfully using our comprehensive approach for treatment of such disorders like:

  • Tarsal Tunnel Pain Syndrome
  • Metatarsalgia
  • Ankle instability or recurrent ankle sprains
  • Variety of other tendon disorders of the foot.

Preventing ankle injury and ankle pain

  • Always warm up your foot and ankle muscles before exercising
  • Achieve ankle motion fluidity (mobility, stability and control)
  • by changing and learning foot specific exercises from Yoga, Pilates, your chiro and physio
  • Avoid excessive wear of high heals
  • Do not wear shoes which don’t feel comfortable
  • Avoid wearing flip flops all the time
  • Train balance

New evidence based and award winning test for ankle stability. Courtesy Maarteen Prins PT PHD

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

mikhail Dr. Mikhail Bernshteyn MD (Internist)
pekar Dr. Christina Pekar DC
michelle Dr. Michelle Agyakwah DC
mariam Mariam Kodsy Physical Therapist

Research at NYDNRehab


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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