Dr. Rock CJay Positano, Co-Director of the Non-surgical Foot and Ankle Service, specializes in musculoskeletal podiatry, lower extremity biomechanics, gait analysis, and sports injury prevention in the active population. Although his residency program at NewYork-Presbyterian Hospital consisted of surgical training, he elected to pursue the specialty of nonsurgical foot and ankle treatment and prevention.
His clinical and graduate work at the Yale School of Public Health/School of Medicine is focused on continuing to find new and innovative nonsurgical approaches and protocols to treating common and uncommon foot and ankle issues, where prevention is the main objective. In addition, Dr. Positano’s research focuses on the role of the foot, ankle, and lower extremity in recognizing the presence of early systemic disease affecting all the body’s systems such as rheumatologic ailments, cardiovascular ailments, neurologic ailments, and diabetes. Finally, Dr. Positano’s clinical and scientific work at Yale specializes in foot epidemiology, which is the study of disease that affects the foot, ankle, and lower extremity.
In addition, Dr. Positano continues to publish scholarly articles in the areas of diagnostic, biomechanical, and treatment entities and is currently working on a textbook that incorporates those disciplines.
Being a multi-sport athlete all of his life, Dr. Positano has a unique understanding of how foot and ankle pathology can develop, whether in the athlete or active professional, and how improper foot/ankle function can adversely affect and cause knee, hip, and back disorders – ultimately impacting someone’s quality of life. His approach emphasizes active rehabilitation and dynamic treatment that adjusts to the stages of healing and thereafter maintaining the musculoskeletal health of the patient. Dr. Positano strives to find solutions for foot and ankle issues that are outside of the box. He specializes in the design, fabrication, and proper application of prescription foot orthoses to treat specific foot and ankle pathology, as well as to treat conditions of the knee, hip, and lower back that are directly connected to abnormal foot structure and function. Dr. Positano’s complementary interests in regenerative medicine, and how it can be a helpful adjunct to healing and pain management, add to this unique approach and bolster the arsenal of nonsurgical options offered to patients.
Dr. Positano has dedicated, and continues to dedicate, his professional education and training to pursuing all nonsurgical means of improving the patient’s foot, ankle and lower extremity conditions and ultimately their quality of life – and only in those rare instances, where all non-surgical options have been exhausted, would he consider and recommend a surgical solution.
Heel pain is one of the most common ailments that is found in the active population. Unfortunately a painful heel can be severely debilitating if not properly diagnosed and treated. It may not be life threatening but it is certainly quality of life threatening and affects a person’s ability to walk, stand, exercise and participate in social activities.
Heel pain is the great impersonator and can signify a wide range of medical problems from a common musculoskeletal problem known as plantar fascia to a cancer metastasis in the heel bone from breast, prostate, lung and other areas. There is no such thing as simple heel pain and this complaint should never be trivialized and relegated to an internet search. All too often we will evaluate a patient who has had heel pain for over a year only to find that there is a more serious underlying problem such as a tear in the plantar fascia.
Interestingly, heel pain is one of the most misdiagnosed musculoskeletal conditions. Physicians often misdiagnose heel pain as plantar fasciitis based on the clinical exam alone or in conjunction with an MRI, without performing a diagnostic ultrasound to rule out other possible causes. The wrong diagnosis can not only prolong a patient’s suffering and decrease quality of life, but can do more harm than good if the incorrect treatment is prescribed. For example, it can lead to unnecessary surgery. Even worse, it can trigger serious systemic health issues such as cardiovascular disease, Type 2 diabetes, obesity, osteoporosis, and depression, due to inactivity and lifestyle changes caused by pain.
Many clinicians as well as the public often conclude that MRI should be the diagnostic test of choice when looking at a heel injury, however, technical advances and higher-frequency transducers have made diagnostic ultrasound technology more desirable than MRI in the diagnosis of foot pain, and it’s much less costly and does not require an often claustrophobic environment associated with the MRI tube.
We published a 2015 study conducted by our Non-surgical Foot and Ankle Service and Heel Pain Center at Hospital for Special Surgery (HSS) and found that a safe and painless diagnostic ultrasound test can pinpoint the exact cause of heel pain and ensure the most effective and safe treatment.
Our findings led us to conclude that diagnostic ultrasound can effectively and safely identify the true cause of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed to confirm the diagnosis. This specialized diagnostic test could spare many people an incorrect diagnosis, potentially harmful treatment and needless suffering.
The pandemic has produced an unprecedented increase in foot problems, particularly in the heel.
Foot pain isn’t just a unidimensional issue. Our experience both anecdotally as well as scientific research has revealed that a painful foot will quite often cause pain and dysfunction elsewhere in the body especially the knee, hip and lower back. What starts in the foot most likely will travel up the motion chain to these other body parts.
Due to the tremendous forces sustained by the foot and ankle on a daily basis this non-surgical service developed specific therapeutic and preventive protocols that help to retard and prevent the rapid development of osteoarthritis as well as degeneration and damage to the numerous muscles, tendons and ligaments in the foot and ankle.
Treatments that include therapeutic ultrasound, phonophoresis, and EPAT combined with a well- designed and prescribed foot orthoses used to stabilize and protect the foot has proven to be both beneficial, therapeutic and preventive in nature.
This benefit also extends to the knee, hip and lower back as improved foot and ankle function and shock absorbing ability is directly connected to decreased force and malalignment of these other parts of the lower extremity.
Diabetes Mellitus is the most common metabolic disease in the world with a global prevalence reported up to ~451 million people and rising and a major source of our global disease burden. Type 2 Diabetes (DM2) accounts for >90% of all cases of diabetes types and typically affects active adults of all ages.
One of the heralding, and perhaps underdiagnosed, features of DM2 is its effect on the musculoskeletal system such as the foot, ankle, knee, shoulder, hip and spine (lower back/upper spine) in particular.
The excess glucose circulating around the body over an extended period of time will start to negatively affect the soft tissue structures supporting our joints contributing, but not exclusive, to common pathologies such as: 1) tendonitis 2) osteoporosis 3) osteoarthritis 4) muscle and foot cramping 5) limited joint mobility syndrome 6) peripheral neuropathy 7) circulatory compromise affecting arteries, veins and nerves.
If left untreated or mismanaged, these issues singularly, or in concert, will disrupt a person’s quality of life because it will affect their ability to move as they please and participate in exercise and walking activity.
This can prove troubling especially if the person leads a motivated and active lifestyle, and can further precipitate the negative cascade of increasing the risk of developing more serious chronic systemic diseases especially involving the cardiovascular system and maintenance of weight control and DM2 related monitoring levels of insulin/glucose indicators such HbA1c, insulin resistance, Body Mass Index (BMI) and other metabolic factors.
Musculoskeletal issues affect the DM-2 patient’s ability to exercise which is imperative to improve cardiovascular function, maintain blood pressure and bone density, anxiety and stress reduction just to name a few.
DM2 patients have specific needs and prevention strategies when dealing with musculoskeletal issues especially if the patient would wish to begin an exercise program or maintain a current one to best avoid injury.
This is the first practice of this kind that directly addresses the musculoskeletal needs of DM2 patients and has the participation of multiple health care practitioners, a specially trained NP (Nurse Practitioner), MD (Medical Doctor), DPM (Doctor of Podiatric Medicine), DC (Doctor of Chiropractic) and a Motion Gait Analysis facility that provides the patient with the ultimate comprehensive musculoskeletal care team approach.
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Co-Director of the Non-surgical Foot and Ankle Service, specializing in musculoskeletal podiatry, lower extremity biomechanics, gait analysis, and sports injury prevention in the active population.
Post Graduate Medical Education:
Yale School of Public Health/School of Medicine
Master of Public Health (MPH) candidate
Preventive Medicine - Foot/Ankle/Lower Extremity
New York College of Podiatric Medicine/Foot Clinics of New York (Doctor of Podiatric Medicine)
New York-Presbyterian Hospital/Weill Cornell Medical College
Podiatric Medicine, Surgery and Orthopedics
One of the goals of HSS is to advance the science of orthopedic surgery, rheumatology, and related disciplines for the benefit of patients. Physicians at HSS may collaborate with outside companies for education, research and medical advances. HSS supports this collaboration in order to foster medical breakthroughs; however HSS also believes that these collaborations must be disclosed.
As part of the disclosure process, this website lists physician collaborations with outside companies. The disclosures are provided by information provided by the physician and other sources and are updated regularly. Further information may be available on individual company websites.
As of July 28, 2020, Dr. Positano reported no relationships with healthcare industry.
By disclosing the collaborations of HSS physicians with industry on this website, HSS and its physicians make this information available to their patients and the public, thus creating a transparent environment for those who are interested in this information. Further, the HSS Conflicts of Interest Policy does not permit physicians to collect royalties on products developed by him/her that are used on patients at HSS.