Conditions · Ankle & foot pain

Ankle & Foot Pain Treatment in Midtown NYC

For ankle sprains that keep coming back, heel pain, or an Achilles that won’t settle.

Hiro Nakano, DC, DACBSP · USA Fencing medical staff · 2021 Tokyo Olympic Games, Team USA volunteer medical staff

How I treat it

Find what’s wrong — and why

A diagnosis from your history and an exam of your ankle, foot, knee, and hip — with an X-ray or MRI only when it will change the plan.^[1]^[2] Then why it happened — balance, calf and hip strength, how you land, and how your training and shoes have changed.

How I work →

Hands-on care, checked on the spot

Hands-on care is the core of my work, learned in our family’s clinic in Japan, opened in 1926, and the same approach I use with USA Fencing’s national team. I choose the method and pressure from that day’s exam, then recheck how you walk, balance, and rise onto your toes right after treatment.

My background →

Home exercise that fits your life

You don’t need to come in three times a week. Ankle rehab follows a clear path — balance, calf raises, then hops — and most of it can be done at home. In one trial, a home balance program done on their own cut repeat sprains by about a third.^[3] I teach it here, we record it on your phone, and I check and adjust it at each visit.

Your first visit →

The ankle and foot pain I see

Most of the ankles and feet I see are sprains, Achilles tendon pain and other long-standing tendon problems, heel pain from plantar fasciitis, and stiffness after a fracture or time in a boot. Some are fresh injuries; others have hurt for months or years.

With most ankle sprains, the pain goes away even if you do nothing. That isn’t the problem. The problem is that the sprain comes back — because the ankle was never retrained, and your body keeps moving in the pattern that led to the injury. Finding those gaps, treating them, and training them is my job.

I don’t take insurance. If you mainly need an X-ray and a basic evaluation, an orthopedic doctor may be the right first stop. If you’re not sure, text me. Sometimes our conversation ends with me referring you to another physician — and I’m happy to do that.

Here is how care usually unfolds.

1. Today’s pain: find what’s wrong — and ease it

With a fresh ankle injury, the first job is not missing a fracture. But not every sprain needs an X-ray. Where the bone is tender, and whether you can walk a few steps, tell us when one is needed.

What the research shows: a short set of checks for bone tenderness and the ability to walk, known as the Ottawa Ankle Rules, was built and tested to pick out the ankle injuries that need an X-ray.^[1] Imaging guidelines agree that when the rules can be used and raise no concern, an X-ray usually isn’t needed at first.^[2]

Pain that lasts or keeps coming back is a different question. Then an X-ray of the bone and joint, and sometimes an MRI, can help — even if the first X-ray was normal.^[4] When it’s needed, I order them directly.

I also work out which tissue is involved. A sprained ligament, an irritated Achilles tendon, and plantar fasciitis each need different protection, a different time to start loading, and a different amount of load.

Then hands-on care to ease pain and restore motion — on the ankle and foot, and on the calf, knee, and hip when they’re part of the problem — and we recheck how you walk, balance, and rise onto your toes right after treatment.

What the research shows: the U.S. physical therapy guideline for ankle sprains recommends hands-on treatment of the joint and soft tissue, within comfort, along with exercise — to ease pain and swelling and improve motion and walking.^[5] After an ankle fracture, though, adding hands-on care to exercise didn’t add benefit on average in one trial.^[6] So I decide case by case, and keep hands-on care when it changes how you move.

Some injuries need a surgeon — a fracture, a torn Achilles, or an ankle that stays unstable despite good rehab. When that’s the case, I’ll tell you why and refer you.

2. Why it happened: the part most people skip

“You just rolled it.” “Sprains become a habit.” “It’s your flat feet.” People often hear these about their ankles, and sometimes they’re right. Some athletes simply have bad luck and roll an ankle. Even then, the goal is to prevent the second injury. When an ankle isn’t trained well and gaps in how it works are left behind, sprains tend to come back. So even a “simple” sprain deserves to be taken seriously.

After a sprain, the pain and swelling settle and you can walk again. But balance, strength, and the sense of where your ankle is don’t always come back on their own. Go back to full activity with those gaps, and the ankle may feel unstable or roll again.

What the research shows: athletes who failed a simple single-leg balance test before the season were about 2.5 times more likely to sprain an ankle.^[7] After a first sprain, people who couldn’t yet complete jumping and landing tasks at two weeks, or had poorer balance at six months, were more likely to end up with a chronically unstable ankle.^[8] People with chronic ankle instability also tend to be weaker — around the ankle, in the thigh, and in some studies at the hip.^[9]

With heel or Achilles pain, the question is why the load keeps outrunning what the tissue can handle. Did your running or walking go up quickly? Is your calf strong enough for what you do? Is your ankle stiff? What are your shoes like, and how long are you on your feet at work?

Poor sleep or nutrition can also keep tissue from settling down, no matter how good the exercises are.

Find what is wrong, then why it happened. That’s where my treatment starts.

3. When the pain improves, we check what you can do

Feeling better is meaningful progress. The next question is whether your ankle is ready for what you want to do.

Walking without pain isn’t the same as being ready to run, hike, or play. So at follow-up visits, I test what your ankle can actually do — and compare it with your other side.

A clear path back: balance, calf raises, hops

Ankle rehab moves in steps you can see and measure:

Walk normally. Calm the swelling and get the motion back, so you walk without a limp.
Balance. Stand on one leg — then with your eyes closed, on a softer surface, and while reaching or catching a ball.
Calf raises. From two legs to one, then with added weight, until the injured side keeps up with the other.
Hops. Hop in place, then forward and side to side, landing quietly and under control.
Back to your sport. Cutting, changing direction, and the moves your sport or activity asks for.

We move to the next step when you can do the one before it well. How your ankle feels the next day tells us whether we moved too fast.

What the research shows: exercise-based rehab after an ankle sprain lowered the odds of re-injury at one year compared with usual care.^[10] An international expert group recommends deciding return to sport on pain, ankle motion and strength, balance, how confident you feel, and hop and sport-specific tests — not on pain alone.^[11] In one study, people who scored low on a set of balance and hop tests two months after a sprain were about nine times more likely to sprain it again within two years.^[12]

Heel and Achilles pain: load it, don’t just rest it

When a tendon or the plantar fascia is irritated, rest calms it down — but it often flares again when you go back to your usual activity. So we cut back the load that aggravates it and build up the load that strengthens it, step by step.

What the research shows: the 2024 U.S. guideline for Achilles tendon pain puts tendon-loading exercise first and doesn’t recommend complete rest for everyone.^[13] The 2023 guideline for heel pain and plantar fasciitis recommends hands-on care and stretching, along with strengthening the muscles of the foot and ankle.^[14]

That doesn’t mean pushing through pain. A fresh tear or rupture is a different situation, and the plan always follows the diagnosis.

A plan that fits your life

New Yorkers are busy, and fitting three clinic visits a week into your schedule is hard. So I give you a realistic amount of rehab, sized to your life, your schedule, and what your ankle can handle right now. Some people balance on one leg while they brush their teeth, or do calf raises on the stairs in their building. That still works, as long as you do it.

Taught in the clinic, done at home

I teach each exercise here, we practice it together, and we record it on your phone. Then you do it at home, on your own time. How your ankle responds the next day guides the next step.

What the research shows: in a trial of 522 athletes after an ankle sprain, an eight-week balance program done at home, on their own, cut repeat sprains over the next year from 33% to 22%.^[3]

That’s why I use visits for hands-on care and checking your progress, and let the daily work happen at home.

The goal isn’t just “no pain.” It’s walking the city all day, running in Central Park, hiking, and playing your sport — without thinking about your ankle.

4. Staying active: turning rehab into a habit

I also treat rehab as the start of your future exercise routine. Everyone needs regular exercise, and everyone has to make time for it. A sore ankle gives you a reason to start — a good opportunity to begin investing in your long-term health. Balance and leg strength are worth keeping for life, not just until the sprain heals.

That’s why I start small. A few minutes a day that fits into your routine is easier to keep than an hour you can’t find. Once it sticks, we build on it.

What the research shows: habits form when you repeat a simple action in the same daily context — like your morning coffee or the stairs in your building. Simpler actions become automatic faster, and missing a day now and then doesn’t undo the progress. On average, it took about two months.^[15]

For many people, an ankle injury becomes the reason they finally start strength training — and stick with it. Many come in every two to four weeks to treat what needs attention and update the plan. Some finish when they feel good; others have kept it up for years.

What the research shows: people who do muscle-strengthening activities have about a 10–17% lower risk of death from any cause.^[16]

Why not just a brace — or rest?

Rest and braces both have a place. The question is what they can and can’t do.

What the research shows: in one trial, wearing a brace during sport for a year after a sprain prevented more repeat sprains than a training program alone.^[17] Exercise-based rehab also lowers re-injury.^[10]

So a brace can be a smart tool, especially in the first months back to sport. But it doesn’t rebuild balance or calf strength, or teach your ankle to land again. Rest calms pain; it doesn’t restore what the injury took. I use both when they help — and the rehab is what lets you rely on them less over time.

Not sure if this fits your situation?

Send me a text and tell me what’s going on. Most questions are easier to answer once we talk.

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Common questions

Do I need an X-ray for my sprained ankle?

Not always. If you can walk and the bone isn’t tender in specific spots, an X-ray usually isn’t needed at first.^[1]^[2] If those checks raise a concern, or the pain lasts longer than expected, I’ll order imaging.

My ankle keeps rolling. Is it just weak for good?

Not necessarily. Repeat sprains often come with balance and strength gaps that can be trained.^[7]^[10] Loose ligaments also play a part, so rehab can’t promise zero risk — but it’s worth finding what can still be improved before you accept it as “just how my ankle is.”

When can I run or play again?

When your ankle passes the steps, not just when the pain is gone. We check balance, calf strength, and hops against your other side and against what your sport asks for.^[11]

Should I wear a brace?

For sport, often yes — at least for the first months back. In one trial, a brace lowered repeat sprains.^[17] But a brace doesn’t replace the rehab, so we do both.

Do I need to come in several times a week?

No. Most of the work happens at home. Many people come weekly at first, then every two weeks, then less often as the ankle gets stronger.

When should I see a doctor right away?

See a doctor promptly or go to the ER if you can’t put weight on the foot after an injury, the ankle looks deformed, your foot is numb, cold, or pale, you felt a sudden pop or “kick” at the back of the heel, or your calf is swollen and painful.

Ready to get back to what matters?

You don’t need to be fit or confident to start. Tell me what’s bothering you and what you want to be able to do again.