How long does Achilles tendonitis take to heal?

Usually longer than people expect. AAOS notes that it may take a few months for symptoms to improve significantly, and that pain can last longer than 3 months even with early treatment. Progress tends to be gradual, so we judge it by what your tendon tolerates from week to week rather than by the calendar.

Can I keep running with Achilles tendonitis?

Usually not at your normal volume while it's irritated. AAOS recommends decreasing or stopping the activities that make the pain worse and staying active with low-impact options like biking, elliptical exercise or swimming. Once the tendon handles strengthening well, we rebuild your running in steps.

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

Not always. AAOS says X-rays are used to rule out a broken bone when you have difficulty bearing weight or tenderness in the bones of the foot and ankle. If either applies, see a physician or urgent care before starting physical therapy.

How do you treat a sprained ankle in the first few days?

AAOS recommends rest, ice for 20 to 30 minutes three or four times a day (never directly on the skin), compression and elevation, with weight on the foot as tolerated. Gentle motion should start early so the ankle doesn't stiffen. The step most people skip comes next: balance and strength work, which helps prevent the next sprain.

Foot and Ankle Physical Therapy in Buffalo | Lake Erie Physical Therapy

Q: What helps heel pain with the first steps in the morning?

That pattern is typical of plantar fasciitis. AAOS calls stretching the calves and plantar fascia the most effective way to relieve the pain, and reports that more than 90% of patients improve within 10 months of starting simple treatment methods. Supportive shoes and less time standing on hard floors can help while it settles.

Three foot and ankle problems come up again and again: an Achilles tendon asked to do more than it was ready for, an ankle ligament stretched in a twist (an icy Buffalo curb will do it), and a heel that hurts with the first steps of the morning. Each needs a different kind of work. Achilles tendonitis physical therapy gets the most space below, followed by ankle sprains and plantar heel pain. First, though, the injuries that need a physician before a therapist.

Rule out the urgent problems first

Physical therapy does not replace a medical diagnosis. See a physician, urgent care or an emergency department before starting therapy if:

You felt a sudden pop in the back of your calf or heel. The American Academy of Orthopaedic Surgeons (AAOS) notes this may mean a torn Achilles tendon and advises seeing a doctor immediately.
You can’t put weight on the foot after an injury, or the bones are tender to the touch. AAOS lists both as reasons for an X-ray to rule out a fracture.
The foot or ankle looks deformed, or the foot is numb, cold or changing color.
Your calf is swollen, warm and painful, which can signal a blood clot and needs same-day care.
You have a fever, or redness and warmth spreading across the foot.
You have diabetes or poor circulation and notice a new sore, swelling or color change in the foot.
A sprain is still swollen or painful several weeks later despite home care, which AAOS says is a reason to be checked for a more severe sprain or a fracture.

Achilles tendonitis physical therapy: building the tendon back up

The Achilles tendon connects your calf muscles to your heel bone. AAOS notes that Achilles tendinitis (also spelled tendonitis) is typically not related to a specific injury; it results from repetitive stress. You may also hear it called Achilles tendinopathy. There are two types:

Noninsertional, in the middle of the tendon, where fibers may break down and develop tiny tears, and the tendon can swell and thicken. It more commonly affects younger, active people, especially runners.
Insertional, where the tendon attaches to the heel bone. It can happen at any activity level, and bone spurs often form on the back of the heel.

Typical symptoms include morning pain and stiffness along the tendon, severe pain the day after exercising, and pain where your shoe presses on the back of the heel. AAOS lists a sudden increase in the amount or intensity of exercise and tight calf muscles among the causes, so we’ll ask about recent changes, like a new marathon plan or a jump in weekend hiking.

What care looks like

Sorting out the type. Insertional and midportion problems call for different exercises, so we check where it’s tender, how calf strength and ankle motion compare side to side, and how the tendon handles heel raises and hopping.
Adjusting load, not stopping everything. AAOS recommends cutting back on activities that make the pain worse and notes that biking, elliptical exercise and swimming are low-impact ways to stay active.
Progressive calf and tendon strengthening. AAOS notes that eccentric strengthening (slowly lowering your heel) can help noninsertional tendinitis, that these exercises can damage the tendon if done incorrectly, and that they should be supervised by a physical therapist at first. Heel drops off a step are for noninsertional cases only, so insertional pain gets a different progression.
Shoe and heel changes. For insertional pain, AAOS notes that shoes that are softer or open at the back of the heel can reduce irritation, and that heel lifts can take strain off the tendon.
Lighter loads when needed. Blood flow restriction (BFR) training uses a cuff on the thigh so lighter weights can still challenge the calf when heavier work is too irritating, after a safety screening.
A graded return to running or sport, with hands-on care for stiff ankle and foot joints when it helps, paced by how the tendon feels the morning after each step up.

Two more points from AAOS: cortisone injections into the Achilles tendon are not recommended because they can cause the tendon to rupture, and surgery should be considered only if pain does not improve after 6 months of nonsurgical treatment. Athletes can read how we handle return to play on our sports physical therapy page.

Sprained ankle: the first days and the rehab after

If you’re wondering how to treat a sprained ankle, start with the reassuring part: AAOS notes that nearly all isolated low ankle sprains can be treated without surgery, and that even a complete ligament tear will heal without surgical repair if it is immobilized and rehabilitated appropriately.

The first few days are about calming things down with rest, ice for 20 to 30 minutes three or four times a day (not directly on the skin), compression and elevation. AAOS notes that early weightbearing as tolerated is typically recommended and that swelling and pain usually last 2 to 3 days.

Then comes ankle rehab, the part many people skip once walking feels normal. AAOS says poor balance often leads to repeat sprains and ankle instability, and that incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain. Rehab moves from range of motion and strengthening to balance work, such as standing on the injured foot with your eyes closed, then to straight-ahead activity before cutting, jumping and sport drills. AAOS estimates the program may take just 2 weeks for a minor sprain or up to 6 to 12 weeks for a more severe one.

Not sure whether you need an ankle sprain doctor or a physical therapist? Trouble bearing weight or tenderness over the bones means an X-ray first. Otherwise, with most plans, you can start with us directly.

Heel pain with your first steps

Pain under the heel that’s worst with the first steps after getting out of bed or after a long rest, and eases after a few minutes of walking, is the classic pattern of plantar fasciitis, a common cause of plantar heel pain. AAOS notes it’s most common between ages 40 and 60, and lists risk factors including new or increased activity, running and other high-impact activity, standing for long periods on hard surfaces, flat feet or high arches, tight calf muscles and obesity.

AAOS calls stretching the calves and plantar fascia the most effective way to relieve the pain, and reports that more than 90% of patients improve within 10 months of starting simple treatment methods. In therapy we add calf and foot strengthening and adjust how long you’re on your feet and in what shoes. AAOS also notes that heel spurs do not cause plantar fasciitis pain, so a spur on your X-ray doesn’t need to come out. For custom orthotics, ask your physician or podiatrist.

When foot pain starts in the back

Numbness, tingling or burning in the foot, or heel and calf pain that doesn’t act like a tendon or ligament problem, can come from an irritated nerve in the lower back. When symptoms fit that pattern, we check your back with McKenzie repeated-movement testing; our sciatica page explains how.

Coverage and your first visit

With most plans, you can start physical therapy in New York without a referral for up to 10 visits or 30 days, whichever comes first, though some plans still require one to pay. Medicare doesn’t require a referral to start; your physician certifies the plan of care. If you were hurt at work, a Workers’ Compensation claim needs a referral from your treating physician, physician assistant, podiatrist or nurse practitioner (how it works), and No-Fault needs a referral after a car accident.

Whether you’re chasing a race goal or just want to get through a shift on your feet, call (716) 332-4838 or request an evaluation. Wear shorts, and bring the shoes you usually run or work in.

Sources

Written by the Lake Erie Physical Therapy clinical team. This page is general information, not a diagnosis; your physical therapist will assess your situation in person.

Physical Therapy for Foot and Ankle Pain