Thomas M. Novella

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30 Years

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(212) 506-0242Call Visit WebsiteVisit Website Map & DirectionsDirections343 W 58th StNew York, NY 10019 Write a ReviewWrite Review

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General Info

Dr. Novella opened his practice in 1982 and has been on staff at Hospital for Special Surgery since being recruited in 1994. Dr Novella’s educational and practice background is diverse. Although his practice targets conservative management of both common and enigmatic foot/ankle problems and body-alignment problems related to the foot, his training has immersed him in all aspects of clinical care.

Neighborhoods

Hell's Kitchen, Midtown Manhattan, Midtown, Hell'S Kitchen

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https://www.hss.edu/physicians_novella-thomas.asp

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Physicians & Surgeons, Podiatrists, Medical Clinics, Physicians & Surgeons, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Orthopedics, Physicians & Surgeons, Pediatrics, Physicians & Surgeons, Sports Medicine, Physicians & Surgeons, Surgery-General, Sports Medicine & Injuries Treatment

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Phone: (212) 506-0242

Address: 343 W 58th St, New York, NY 10019

Website: https://www.hss.edu/physicians_novella-thomas.asp

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Thomas M. Novella

General Practitioners

Warts
Arthritis
The first foot specialist he consulted had diagnosed rheumatoid arthritis, although the rheumatoid work-up came back negative. The doctor then proceeded to administer six unguided cortisone injections into the joint, one per week, without favorable response. The next specialist diagnosed osteoarthritis, though the range of motion in the joint was uncharacteristically (and to me even startlingly) copious, and serial X-rays remained negative for arthritis. This doctor tried two ultrasound-guided cortisone injections, again, simply into the joint. By now and after eight cortisone shots, his symptoms were markedly worse. The only offering which doctor number two could make by then was “take it easy”. Our teacher had to stop his tennis and jogging. He began to gain weight.
Plantar Fasciitis
Around that time, about three years before she came to visit me, she started to experience the pain about the insides of the arches of both feet. This pain worsened about the same time that her hip/knee pain went away. She saw three podiatrists for her foot pain, all diagnosing the problem as plantar fasciitis. Each made her a different pair of orthotics. None of the orthotics got rid of her foot pain. I checked each pair. Two of them looked very adequate in terms of arch contact and the wedges which were affixed to them per her foot mechanics.
Pediatric Care
Back around 1980, when I had just finished my surgical residency and my orthopedic-biomechanics and pediatrics fellowships, I was offered a consulting position at one of the rare dance medicine clinics in NYC by a biomechanics fellow who was leaving this post at the clinic and moving to Maine. I immediately recalled an article I’d read in a newspaper when I was younger, about Edward Villela who was told he was dancing on shin splints, would get to the to theatre on crutches, perform heroically, and go home on crutches. It turned out he was dancing on nine stress fractures in his shins. I said to myself, “I’d like to be a doctor and treat patients like that.” I took the gig.
Family Practice
I feel my career has been shaped in a very unconventional way compared to my podiatric colleagues. Early on I was welcomed into collaborations with top orthopedists, physical therapists, chiropractors, osteopaths, family practice physicians, and rheumatologists within the first six months my career.
Emergency Care
"No, I went to the emergency room, and they put me in a soft cast and took X-rays and said nothing was broken."

Carpal Tunnel Syndrome
A 46 year-old Mexican gentleman visited me on referral by two top NYC foot orthopedists. He'd had surgery six months previously to release pressure on the nerves in his ankle. The problem began after he'd started running to lose weight in four-year old running shoes, which offered little support. This condition, called "tarsal tunnel syndrome," causes pain, burning, and aching further down into the foot. It feels like something is wrong with the arch and big toe, when actually the problem stems from forces compressing the nerve in the ankle that distributes to the arch and toe. It's similar to "carpal tunnel syndrome," which you may remember was prevalent in the early days of computers when so many people took up keyboarding. Remember how this started some new keyboard designs?

Depression

Ultrasound
She returned two months ago, stating she’d been experiencing heel pain. She hadn’t started any new activities, or otherwise recollected any trauma or distance walking without her orthotics. This time she was convinced she needed new orthotics. After we talked, I found that her heel pain was pretty much on the wane, although she was noticeably worried it might come back again. I methodically poked her foot, minimal heel tenderness, and not at her plantar fascia, but at the back corner of the heel which gets that first impact with each stride. I checked her orthotics…again perfectly appropriate. I deferred doing an ultrasound scan which is a bit costly, especially if circumstances don’t warrant it (although I use the scanner quite frequently for heel pain if the presentation portends it would help me organize the problem).
MRI
This very affable dancer came in to see if there was anything I could do to help a feeling of pulling and spasm in the sole of his foot and in his calf. He wondered if orthotics might help in his dance shoes. As we were discussing his history, I found out that his foot problems started about ten years prior, when he was dancing in ballet shoes which irritated the sole of his foot so much where their seam was that a small internal scar was created on the nerve to his big toe. His MRI showed this scar tissue, and nothing else of note. Since then, if he were to do a few full relevés (tip-toe moves) he'd get extreme shooting pain into his toes. So he had to avoid full relevés.
Radiology
I asked him to have a stat MRI of the ankle. I called my radiology buddies and asked them to give him an appointment the following AM. The images came in online, and I was able to look at them over lunch. I looked carefully at the ankle images. As my radiology consultant also noted, there was no pathology, though those toe muscles were robust. Fortunately, my 2 hours every evening since 1994 looking at foot and ankle MRIs occasionally pays dividends. I looked specifically for the two muscles which surround that medial plantar nerve. Now the muscle which controls the lesser toes, the flexor digitorum brevis, was originating on his heel bone from an unusually-situated place up on the arch-side of his heel bone, rather than in the middle where it belongs. This was trapping his medial plantar nerve against the abductor hallucis (big toe) muscle, the very muscle at the site of the pain. I postulated that this process was causing referred pain to the complaint site as those robust toe muscles, compensating for the calf weakness, relentlessly popped his heel off the ground as he walked.
X-Rays
Computed Tomography
Two more docs said his problem was flat feet, and indeed, his right foot was flat. His flat right foot, even when he stood without walking, flagged something I would look for later in the exam. Each new doc made him two pairs of custom orthoses, a pair for business shoes, and a pair for sneakers. All four pairs looked remarkably similar: plastic arch supports which terminated short of his big toe joints. None had altered his symptoms. He’d had over 30 X-rays and a CT-scan: all negative, oblivious to the radiation exposure for someone who’d had lower extremity cancer. He brought all his imaging discs with him, including a recent MRI, which had been read by a radiologist and a podiatrist as completely negative for pathology about the great toe joint (my favorite kind of MRI). He’d also brought with him his affect of unchallenging willingness to accept any treatment plan. His well- grounded faith in doctors had arguably become his greatest problem.

Orthopedics
My most important and constant debt I have regarding those who had the most influence on my career is of course to every single dancer who’s trusted me to be their doctor. To any particular individuals, I must first bow profoundly and equally to two giants. Richard Schuster, DPM, my orthopedics and biomechanics professor during my schooling and fellowships, who taught me to think outside the box and elevated my appreciation of functional human biomechanics from the academic to the sublime, and William Hamilton, MD, the orthopedist emeritus to the NYC Ballet who trusted me to work with him through the first 38 years of my career until his retirement, from whom I learned so much, but nothing greater than to approach every patient with the attitude that it was I who was sitting in the examination chair and thus how I would expect to be treated.
Sciatica
She’d then been placed on an experimental drug which had shrunk the lesion considerably and simultaneously helped her in her battle with the lymphoma. During this time, both her sciatica and her heel pain lessened considerably.
Pinched Nerve
She'd had ankle surgery at the age of fifteen to remove a piece of bone blocking her ability to pointe. Later she took significant time off for a pinched nerve in her low back that had prevented her from executing arabesque, and had incurred multiple sprained ankles thereafter. She'd graduated ballet school at the age of 18, and despite the down time was immediately recruited by three of the world's top companies without so much as an audition. Having danced professionally for barely a year, when she came to see me she was enduring a bizarre ankle injury that had prevented her from dancing for the prior three months. She experienced pain and clicking all around both sides of her right ankle whenever she tried to go up on tip toe. She'd worn high heels to a party the night before visiting me, and presented to my office limping as a consequence. Her orthopedist had just performed another thorough exam, as had several physical therapists. Recent X-rays, MRIs and CAT scans were all completely clean. She had just moved from her company city in Europe to New York City to visit the dance doctors here until she got an answer. No one had an answer. Still what struck me most was her cheer and her personable way.
Ankle Surgery
On the plus side, she had copious pointe, so the bone-removing ankle surgery had been supremely successful, and very strong sprained-ankle protector muscles (the peroneals). That was great. One less hurdle. I also realized that she must be dancing in some pain in all these injury and surgery sites, but never felt the need to report it. When dancers grace my office I regard them as demi-gods. If there has been any constant in my career, it's been the degree of professionalism and sacrifice dancers demonstrate through their willingness to live with pain throughout their careers. This young lady was a poster child for the a priori knowledge dancers have that they will get back to dance if they just can figure out what is wrong. They don't give up. Imagine how this has bolstered my tenacity when I try to figure out people's problems. I will forever be indebted to dancers for the inspiration they have given me.
Bunion Surgery
About a score of my 1,000 patients per year visit me convinced they must have bunion surgery. Trouble is, it's often family members, or regrettably, even doctors who are doing the convincing, not the patients themselves.
Bunions
Even though it is published that bunions, for example, are hereditary, and can be caused by trauma, being a ballerina or a gymnast, or even just having flat feet, there is nothing published stating that anything actually prevents bunions. This includes orthotics. It's been tough to design a study which takes all the variables of daily living into account. Such variables as sometimes wearing shoes appropriate for orthotics, then sometimes wanting to wear shoes that orthotics don't fit in. Of course some orthotics are made better than others. Also, we usually walk around our house or the beach without orthotics, etc., etc. So scientific method loses due to long-term life variables. And no study would be safe for its population if it had people wearing an orthotic on one foot and no orthotic on the other foot for thirty years and then seeing what happened.
Ingrown Toenails
Hip Replacement
This case dovetails nicely with the previous case of the businessman with the ankle pain. That's because it also has to do with leg length differences. One of the most frequent "side effects" I see in patients who've had hip replacement surgery is a difference in the length of their legs. I imagine it must be extremely difficult for a surgeon to assure that leg length will be symmetrical after hip replacement, considering variations in bone density, seating of the prosthesis in the bone, muscle contraction, preexisting leg length differences, etc.

Plastic Surgeons

Plastic Surgery
Surgical resident, performing hospital admissions, 210 foot cases, assisting on mediastinoscopy, cholecystectomy, TUR, hip replacement surgery, varicose vein ligation, carpal tunnel release, facial plastic surgery, and general abdominal surgery; emergency room rotation, and wound management; grand rounds. Residency at and under the auspices of New York College of Podiatric Medicine, including substantial time at Jewish Memorial Hospital, Beekman Downtown Hospital, Hospital for Joint Diseases, Peninsula Hospital, Veteran's Memorial Hospital, and St. Barnabas Hospital.

Dermatology
Corns
We all know you can visit a podiatrist to have your corns trimmed on a regular basis. But very often putty toes eliminate the need for all but the infrequent visit for trimming, if even that. So I'd best describe these little talismans. Simply, they're reusable, durable hand-made rubber-like forms which fit in all but the absolute tightest shoes (they fit in pointe shoes). I mold a quick-curing silicone around the toes and anticipate the position of the toes within the shoes intended. I anticipate the shape of the shoe toe box, and simply hold the clay-like material around the toes in question for 15-30 seconds until it assumes its permanent shape.
Cyst
Ulcer
Ulcers?I have a love/hate relationship with ulcers. I'm extremely strict at getting rid of the cause of an ulcer. I had wonderful training in my residency, and this mixed with my love of improving contact forces gives me a high degree of confidence when I exorcise a mechanical cause for an ulcer. The problem is ulcers require frequent visits and I may not have a convenient spot in my schedule for you available at your required frequency. I'll see you to eliminate the cause of your ulcer, but may refer you to another podiatrist or a wound management specialist for your repeat visits. I'll probably ask you to return to me at critical junctures to make sure things are going according to plan.
Calluses
This is an eighty-minute seminar lab in which elite ballet students learn principles to help maintain healthy feet and ankles throughout their careers. Topics include: common dance injuries to the foot and ankle; keeping a history of changes in your routine; when should I see a doctor? screening for the right doctor; what to say to a doctor; what to expect from a doctor; recognizing infection; immediate care for your injury; maintaining ankle and foot strength; proper street shoe selection per the individual dancer; fitting and discarding pointe shoes; ballet slipper selection; toenail maintenance; padding your foot for injury; pros and cons of cortisone shots; advances in tissue regenerative therapy; do I need orthotics? warts vs corns vs calluses vs ulcers; neuromas.
Lesions
Her X-rays were non-contributory. She’d had several sets. She’d had a high-radiation CT scan, which was also non-contributory. She’d had an MRI, looking for tendon or ligament tears, stress fractures, or space-occupying lesions pressing on her nerves...again, fruitless. She’d had ultrasound scans, again, no pathology was noted. She’d been told her problem was everything from plantar fasciitis to sciatica. My two NY colleagues, as well as myself, were convinced it was “tarsal tunnel syndrome”, which is akin to the carpal tunnel syndrome many typists get when not sitting at the keyboard ergonomically. Not atypically, her nerve conduction studies were not definitive. Adding to her diagnostic misfortune, ironically, none of the expected causes for tarsal tunnel syndrome showed on the MRI. Thus her consultants were afraid to take invasive action fearing making her worse. <1. e4 e5> *

Physical Therapists

Sports Medicine
Sports medicine was in its infancy. I was a consultant in a sports medicine group practice back in the early 80’s, collaborating with a physician and a physical therapist, treating Olympic and world class athletes for Adidas Running, Track and Field. Thinking about my personal and the general advances in both diagnostic and treatment procedures then versus now...I only wish I had what is now available back in those times.
Physical Therapy
When she first came to me, this previously-athletic young mom had had 12 years' pain in the ball of her foot. She was given orthotics back then which helped the problem somewhat, yet the pain persisted. Soon after getting the orthotics she developed pain in the middle of her foot at the tendon which pulls her foot up. She was then prescribed physical therapy. The physical therapists prescribed strengthening of the tendon. Her tendon pain worsened. She stopped the therapy, and decided to change her lifestyle and take athletics out of her life. Her tendon pain lessened, but persisted minimally, as did the pain at the ball of her foot, for the remainder of the twelve years before she first visited my office. She was referred by her husband, a tennis player who was a long-time patient of mine. He hoped I could get her well enough so they could play tennis together again.
Flatfoot Correction
Heel Pain
Ankle Sprain
Now it's time to let you in on the circumstances that I pieced together, and the treatment plan and results we obtained. I believed her ankle sprain was the cause of the problem, despite the time lag between the sprain and the onset of her great toe tendon pain. You see, when a person sprains an ankle, about 40% of the strength in the muscles that protect against another sprain is instantly lost. Until this strength is regained through properly-executed exercises, and I emphasize properly, the ankle will have two distinct positions: a position of stability, and a position of instability. The position of stability for such an ankle is in the heel-down or foot-flat position, the position she displayed on the involved side as she walked. The position of instability will be in heel-off or tip-toe position, the position her uninvolved side happily displayed during the latter half of each stride. The tip-toe position is unstable for a number of reasons including muscular, ligamentous, and joint, until properly-executed exercises regain strength in this position.
Manual Therapy
Custom in-shoe orthoses, ’12, Hospital for Special Surgery, symposium, “The Foot and Ankle: Current Topics and Manual Therapy”
Orthotics and Prosthetic Therapy

General Podiatry
I'll let you in on a little secret. When there's a disparity like this, there usually is a little gremlin in the mix causing trouble. In the world of podiatry this gremlin is usually shoes, orthotics, or pads, and it may also be exercises ostensibly being performed for "therapy." As we were talking, we uncovered that he'd been wearing the same three pairs of shoes for the last nine years. He kept getting them resoled. Red flag, red flag!
Ankle Sprain
Her pointe range was fine. Her plie was too deep. Her calf was way too flexible. Her big toe joint had plenty of releve, and her big toe muscle, the flexor hallucis longus, yes, the one causing the problems, was disproportionately super-strong. Her peroneals, or outside ankle protector muscles which weaken after a sprained ankle, were strong when I tested her with her foot at 90 degrees to her leg, but when I tested her in the pointed position, these outside ankle protector muscles were terribly weak. Her peroneals and calves were much too weak for such a powerfully-built young woman. Her ankle ligaments were a tiny bit unstable. Her other muscles were normally strong, her leg length even, her hip turnout perfect. The jigsaw puzzle was now spread out on the table in front of me, and I could already envision what the picture would look like.
Bunions Problems
I know many of you may have a concern that you or your child may develop foot problems similar to the elders in your family. I agree that it's published that many problems, including arch height and bunions, are hereditary. And with today's technology, who wouldn't want to take advantage of what's out there and prevent their child from having such problems? I for one would love to. Only one problem.
Calluses
Flat Feet
Hammertoes
Two long-time patients came in to see me yesterday. They and about 35 others keep coming back every 6-10 months for what my dancers call my "putty toes." Though I make putty toes for ballerinas and Rockettes, most people who come in for them are not dancers, but housewives, moms, businesswomen, lawyers, and the occasional businessman. They're people who had been told by one or more other doctors that they had no choice but surgery for their painful hammertoes. Fortunately for several hundred patients in my 28-year career, there are non-surgical alternatives.
Heel Spurs
Let me tell you a little story about heel spurs. Just because you have a heel spur, it doesn't mean you are condemned to heel pain for the rest of your life. In fact, just because the X-ray shows a spur, that does not definitively nail the diagnosis. I give a lecture about heel pain. I start the lecture with seven slides. Each slide is an X-ray of an individual's right and left heel. There is a heel spur on one foot only in each of the slides. The reason I start my lecture with these slides? Because in each patient, it was the heel without the spur which was causing the only symptoms. This means the doctor has to do a little more delving before setting you up for a standard treatment regime. You might, as in this patient's case, get worse.
Heel Pain
Foot Pain
Ingrown Toenails
Other things I don't like to do? Though I love salvaging nails from unnecessary surgery, and teaching patients the right way to cut them, I don't love treating severely ingrown toenails. I'll do them, and be certain to do a thorough job. I just don't like them. I love dermatology, was tops in my class in dermatology, but not being a surgeon, I don't biopsy, so I might refer you.
Foot Injuries
Foot Neuroma
An elegantly-dressed gentleman presented not long ago in mild distress/despair. Seven years before coming to my office, he visited a podiatrist, whom he likes very much, in California, where he used to live. He had considerable pain at the ball of his foot, which she diagnosed as a Morton's neuroma (a collection of scar tissue about a main nerve bundle which supplies the third and fourth toes, causing shooting pain into the toes). She gave him a cortisone shot, a pair of orthotics incorporating a neuroma "plug" on their top surface designed to spread the bones pinching the neuroma, and his pains went away for two years. She also advised him to stop wearing his tight pointy shoes, likely the cause of the neuroma. All good advice. He moved to New York City five years ago, shortly before the pains at the ball of the foot came back. He visited another podiatrist, who suspected the problem recurred due to the increased walking many patients report on moving to the Big Apple. As the orthotics had theretofore been successful, neither podiatrist nor patient thought there should be a change in the orthotics.
Pediatric Foot Care
In 1980 after finishing my surgical residency and my pediatrics and biomechanics fellowships, I was hired as a clinical instructor in orthopedics and biomechanics at the NYCPM. I taught at their adult and pediatric foot and ankle clinics in Harlem, considered one of the busiest and best in the country at the time. There I had the opportunity to meet several dancers at the clinic looking for help.
Plantar Fasciitis
After a little Sherlock Holmes work, I felt fairly certain to have nailed both the diagnosis and cause of her heel pain. I didn't think the foot problem was part of the old issue, nor think it would be lifelong. I also gave her some ideas to pursue about the long-standing problem in her legs. By examination I determined her heel pain was due more to bruising than the well-known and dreaded plantar fasciitis. And though she could recall no injury, activity or body-weight change which could have set it off, the clue for me was the time that it started. Right in the middle of the summer. The summer shoe of choice this year?...flip flops. When I asked if she'd worn flip flops this summer, and did she wear them more than she'd ever done before, the answer both times was yes.
Podiatric Orthopedics
Dr. Thomas M. Novella, (D.P.M.), has been continually practicing in New York City, New York, since 1978. He is a long-term adjunct professor of podiatric orthopedics, with extensive teaching experience, extensive clinical experience, and comfortable with a multidisciplinary approach integrating whole-body mechanics.

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