I swim around 1 mile 3 times a week, yesterday I felt real pain while swimming and couldnt continue as pushing off the wall wasnt an option. The pressure should not normally take longer than 5 minutes to return to normal levels. But it can definitely be done, it just has to be a slow and methodical approach. At rest or in MTB I have no discomfort . The tibialis posterior muscle originates in two heads at the interosseous membrane and the posterior surface of the fibula. How many toes are visible from behind? As the run progresses this pain can actually disappear completely. Is there anything I can include, continue or avoid doing (from what I have mentioned) that can help. Pain in the lower leg, either in the calf muscle area or on the inside of the shin. The diagnosis of MTSS describes exercise-induced . It sounds like you are slowly improving. This further demonstrates the ambivalent attitude towards the syndrome. I am diagnosed with PTT in my left foot. Hi Ben I knew this was PTTD as I had plantar fasciitis earlier in my right foot also. The material is basically a thick rubber band designed to apply short intermittent compression while you perform 1-2 exercises or stretches. The thing is I was born with flat feet and have had plantar fasciitis in the past. 3. When they did the MRI 3 years ago they said I had some micro tears, but it was relatively benign pain that would only flare when I did treadmill or play basketball How have you been since this? Just make sure you havent missed anything that is out of balance up the kinetic chain. The good news is the pain is finally at a low enough level where I can actually DO the recommended exercisesthat was my biggest issue before everything I did to help just aggravated the injury more. There will likely not be a specific technique that fixes this but a series of things that leads to resolution. I am now up to 10k, so Half Marathon goal is 3 months, all being well. Its a long time since you posted your situation and I hope you have recovered. That is slightly different for everyone, but since we are going into an off season taking more time to fully heal and recover is probably the prudent strategy so you can come out strong in 2018. This nerve is a branch of the sciatic nerve. The goal would be to then continue working on foot, ankle and hip strength to help support the tendon and the ankle foot complex. I do have flexible flatfeet which I never knew and never bothered me until this ordeal. The pains throughout your body are likely due to the change in posture and asking your body to behave in a completely new way. When you return to running be sure to slowly taper up the distance. Your involved foot and ankle is as mobile and flexible as the other. Posterior tibial tendon dysfunction (PTTD), also known as posterior tibial tendon syndrome or tibialis posterior syndrome, can develop into a tibialis posterior tendon insufficiency which causes a fallen arch. Let us know how it all comes out. I seemed to have developed this condition very suddenly. Thanks for the update and nice work on the race. We recently went to an orthopedic doctor who is attempting to get her a referral for a MRI, but at this point she is quite frustrated. Have you had an actual video gait analysis to see if there is a small issue with your running form that eventually gets you as the miles add up? Remember connective tissue takes a very long time to adapt unlike muscle or your cardiovascular system. It inverts and plantar flexes the foot, and supports the medial arch of the foot. Took everything slow and easy but by week four the pain was creeping back in. What would you suggest in terms of a warm up routine for early runs and more importantly races? Though sometimes difficult to detect an MRI is probably a good choice. Usually places to start are calf tightness, hip weakness and maybe running form issues. I think that its due to a one time overuse rather than chronic issue, so I think its just a question of letting heal rather than form correction. I ran in the Brooks Pure Flows until the end of 2015 (after my 2nd marathon) when their updates made my feet hurt. . Given your history of PTTD I would also be concerned about worsening it, so the exercise program will just have to be slow. All together it is working. Meaning either something is off with your running form or you have a muscle imbalance somewhere up kinetic chain (leg, hip ect). The tenting effect of the posterior tibial, flexor digitorum longus, and soleus tendons caused by muscle contraction exerts a force on the distal tibial fascia that is directed to its tibial crest insertion. 1. Problem arose after a 13-miler last weekend, which was at normal training pace, even a bit slower. Thanks, but youre probably my 8th opinion, getting desperate here I bad bone scan and MRI which shows nothing, as well as ultra sound. As you can see from the above posts it can be a difficult problem to get rid of when chronic. Have any of you run a marathon with posterior tibialis pain? If they suspect chronic compartment syndrome then they will perform pressure tests both before and after exercise. Hello Ben, I recently got custom ones, but that seems to be the same problem. She has been in a CAM boot for the past 5 weeks in her left foot, and it has had virtually on affect on the pain level (although the arch is slightly higher in this foot than the right). I am also utilizing an AFO for further support. This could explain the pain that occurs only after several km of running. She did four months of PT, which seemingly exacerbated the problem. Best of luck! Hi Paul, Great question. I limit my walking. The best defined risk factors for lower limb overuse injuries in general, and stress fractures in particular (there have been essentially no studies specifically dealing with the prevention of shin splints) are those intrinsic factors of female sex, high Body Mass Index, poor pre-training level of physical fitness, the presence of a lower limb deformity and a history of lower limb injury. I can stand on my toes both sides no problem. In cases like this I use the rule of thumb.if it is too tight then loosen it, if it is too loose then strengthening it. Lets look at different injury as an example. Once I was out of the brace, I got fitted for orthotics for my sneakers. I iced it tonight and did 3x calf stretch and used a roller! Swollen ankle and i cant do any raise heel or move my ankle front or sideways. Within 2 weeks, the right foot began to mirror the left, pain-wise. I cant believe all I have accomplished in the last year. . Any thoughts or ideas would be greatly appreciated. This group has been very benficial and motivational during my training. Its never hurt until Tuesday and its the exact place so I know it is this! I would also look at the mobility of the big toe. I took about five days off from leg workouts and then tried a light bike ride which went fine. I have tried several types of supportive shoes like Asics Gel-Nimbus and GT1000, and most recently the Saucony Redeemer which is supposed to be one of the best. If it turns out the tendon is partially torn then there is a chance that physical therapy may be of benefit. Same thing happened with calf issues, then shin splits, now its this thing. I also really feel it when I wrap that area with voodoo floss and stretch that area with me knee bent. Instead, initially focus on any other mobility and myofascial restrictions in the lower legs. It will help you prepare for surgery. Lori.thank you so much for the kinds words. Mike.I have to say I have not heard of the tendon splitting that way either. You mentioned some of the manual techniques the PT did but were you doing any specific foot and ankle exercises and did the PT ever assess the mobility of the foot particularly the forefoot? (The orthotics have helped some of this), At this rate of walking about 30 minutes a day or less, its going to take me 30 years to build any muscle tone. I am pretty sure I will still run the marathon as I am not in agony like in 2018 and it is my last change with my ballot place but I know I will be in pain at the end and that is not how I wanted to remember my first marathon. Im feeling slightly better than a week ago, but still exhausted, not sleeping well because of the pain. I would expect a very slow and long recovery possibly 4-6 months post procedure given the treatments she has already done and lack of success. I am so down with this as I cant do anything in my life that I enjoy, dog walks, golf taking my 3 month old baby out for a walk. The confusion that surrounds just what does constitute shin splints is reflected in the multitude of alternative names for the condition: posterior tibial tendonitis, anterior (or medial) shin splints, soleus syndrome, tibial periostitis. and also starting to put on weight I have been doing hip mobility, stretching out my calves, standing on my tiptoes and slowly lowering down and apparently (according to a physio I saw) I bashed where the ligament that reaches up to my toes crosses over with the tendon, so have had difficult moving my toes too but am doing exercises to try and strengthen that. The pain has subsided substantially over the past 8 days now, but it is still tender and particularly after doing calf raises or walking a lot. Joana.It sounds like it was a tough experience but it should not be lost that you just ran 26.2 miles. Its perfect running weather right now and Im dying to get back out there! Keep us posted! I went out and bought some arch supports and replaced the insoles in my New Balance walking shoes. Do you have any advice for me? Moreover I was told I do have strong glutes, they were just difficult to activate and that has definitely improved for the past months. Ben. You may also find the Resilient Runner program on the MTA website is a great resource to help you self manage any issues that come up. Also be sure she is very diligent in working on the other aspects of the program especially lower leg strengthening. The other option is to see a physical therapist that works with runners and have an evaluation and then see if he or she can give you a home program. This is why chronic tears demonstrate associated flatfoot deformity, with plantar flexion of the talus often seen on sagittal MR images. Sir please guide me what shall i do .next month is my joining to physical training programme. Ive been taking Aleve with tylenol and that only just barely cuts some of the pain. And be sure to continue with the strengthening protocol. Exercise 1: Ankle Inversions with Resistance Band. Hi Im a 16 year old competive runner who has ambitions of running at a division 1 level. She also did a diagnostic numbing of the PTTD which resolved the pain for 4 hours, including up the calf. I have made it. Also gluts is a loose junk term. I know ice is recommended for pain and/or swelling but would heat be beneficial to aid recovery also? Keep focusing on the rehab, but I wouldnt progress mileage until the pain ticks down a notch. Hope that helps. I just really want to go back to not having pain in that foot. Hi Ben, thank you so much for that prompt reply. Yes rest would be advisable as well as working through the exercises suggested in the post. So he increased my program to include a lot of strength and balance like one legged stands, squats, walking sideways, heel raises, and I was able to do them. Is it possible to do a full marathon..you bet! I took Monday off and then did an easy 5-miler yesterday; the pain got gradually worse, though never incapacitating, starting at around mile 3 (I would have stopped under normal circumstances, but was running point-to-point and had to meet someone), and now this morning its stiff and sore; walking hurts. I felt my calf tense/seize up for about 30 seconds (the longest 30 seconds of my life..). Peritendonitis of peroneuslongus and bone oedema of the plantar calcaneocuboid joint with no Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The tibialis posterior muscle had no attachment to this site. I am now up to 10k, so Half Marathon goal is 3 months, all being well. For now hit the rehab hard then decide after a week if the HM is doable in 2 weeks. Still, some mornings were pretty uncomfortable and I had to walk around on my tip toes until the tendon warmed up and stretched out. Im pretty sure I have hip impingement to. These injuries occur when there is abnormal stress/ load on normal bone, as opposed to fragility fractures where there is normal stress on abnormal bone. I have grade 4/5 tiblias tendon weakness and significant degenerative tendonopathy. Good luck! The joint mobility of the foot needs to be assessed and a very slow but graded foot and ankle strengthening program should be initiated. Hi Ben, You mentioned flat feet and over pronation I wonder if some of your symptoms are in relation to improper foot position. Hope that helps! Stay focused on the positive and making small daily improvements. 1 Bencardino JT., Rosenberg ZS, Serrnao LF. The most common issue is pain with prolonged exercise particularly running sports. I can run on it without it hurting but i am limping a little bit. Thank you so much, Ive dealt with running injuries in the past but none that have lingered like this has, HI Chris, If you are going to introduce an orthotic then you should not go back to jogging for several more weeks until your foot has gotten used to the orthotic. Excited to start my slow comeback this weekend. It is possible to have this condition without a specific injury especially with certain types of foot positions and walking patterns. The ultrasound scan shows a tear in the tendon. I run mainly on an undulating (moderately difficult) dirt trail where the footing is unfortunately less than good which makes it even more challenging on the lower legs. After a physical examination, a doctor suggested that it could be PTT but I have not suffered any injury. When finished, I had a lot of soreness on the inner ankle area which I iced immediately. About a year ago, I started having pains around my arch because my feet started becoming flat. I have been having pain in what I think it my posterior tibial tendon for the past two weeks. One must keep in mind that your cardio vascular system can improve rapidly but the musculoskeletal system will take longer. It really depends on how painful the area is. I was never really given any help towards rehabilitation before except for the orthotics. Are there other things I can do to maintain fitness without affecting the PTT swimming or cycling, for example? Thanks! After 8 weeks of strengthening and PT my legs are still hurting. Radiographs or bone scans may be obtained to rule out stress fractures. Unfortunately this advice wont help in time for your trip but you may want to consider prolotherapy. I would probably not wait to start back on your PT exercises though. I also recently started wearing a semi-rigid orthotic any time with my shoes. Roentgenol., Sep 2000; 175: 627 635. I didnt do any running for a full year and tried to strengthen and improve flexibility with exercises similar to those above but didnt seem to come with much success. This was supposed to be my bucket list experience but I was supposed to enjoy it and give it my best. No visible redness or swelling at all. The best advice I can give you is to start very slow and methodical as you work through the issues of PTTD on both feet. Cheryl you are so welcome. You can use a lacrosse ball to self mobilize the foot working at the arch and base of the big toe. Simply reducing running mileage, or training load to 50% of normal may be enough. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.). Weird aches and pains can be a sign of worn out footwear. I am definitely going to get going with the rehab exercises. Ive been moderately active for almost my entire life, and started to run and train for a HM in June 2016. The only other thing I would recommend is trying this taping technique. Another muscle commonly involved is the tibialis anterior muscle. Working up to high reps and high load. If it doesnt help, I may go to an orthopedic surgeon for another opinion. Sometimes having a rubber or felt type coating over the harder plastic can help with discomfort from the orthotic. You want to make sure you get the right style for your feet. The first week of taper I felt fine; I ran a 14-miler last Saturday (two weeks out from the marathon) with no issues, but then Sunday I felt some PTT pain in my left foot and stopped a mile into my recovery run. Keep us posted! Ben. One month ago, I began to perform strengthening exercises as per my doctors instructions. During my time off, Ive also tried to address possible hip/glute weakness as I read this can be a cause. I am so sorry for such a long story. I am also wearing a PTTD aircast, which for now gives me a boost in my arch. If you rehab well I would expect you to be back out on the golf course doing what you love. Injections of the medial tibial border with corticosteroids have bene met with limited success8. There are not usually symptoms during gait but symptoms may be present in running. js.src = "//forms.aweber.com/form/02/1626559102.js"; My theory will aso be to lose weight as a compliment to adding weight in tandom, does that make sense I.e. If you have just started running and it came on this fast the most likely cause is in appropriate footwear and progressing your running faster than your body was able to handle. Good idea to have a massage. var js, fjs = d.getElementsByTagName(s)[0]; 2. When there is post-tibial tendon dysfunction (PTTD), the tendon does not function to hold up the arch, resulting in flat feet. Years later I believe it is back. What do you say? You may have to take 6-8 weeks off from running. If the procedure goes exactly as planned then after appropriate healing and rehab you may well be on your way. The doctor told me to take two weeks off running and then reevaluate. After this illness, I wanted to slowly get back into shape and began taking walks (about a quarter mile) in the evenings. Its been 4 months since then. Hope that gives some food for thought on the warm up. Be well ! Symptoms may include shooting pain, numbness,and tingling or burning sensations. What do you suggest I do? Waking up was the worse and the first few steps were terrible. Any discussion on surgery should include a thorough consideration of a persons health status and the risk vs reward benefit. This is very very helpful and I will definitely let you know how it goes! You wrap the band around the foot and ankle then do some ankle pumps and deep squats to get the ankle moving. He said that my MRIs and ultrasounds look fine with no tears, etc. These cookies will be stored in your browser only with your consent. I hope you dont mind me leaving a message. Just wanted to stop by and say thanks. PTTD is bad enough on its own without ongoing other issues. Ive finally been able to sleep, the nerve pain is gone, thank the Lord. At this time, i was walking around in oofos flip flops and i thought:this pain should go away with some rest. (early stage 1 PTTD). You sound like an extremely compassionate physical therapist to help so many! Either way it sounds like it will be difficult not to walk or climb stairs so you will have to do the best you can. The most common mistake I see in treatment that prevents a full recovery is failure to look at other areas of the body that are likely possibly the cause of the PTTD. The following terms are all used: Posterior tibial tendon dysfunction (PTTD) Posterior tibial tendon syndrome Tibialis posterior syndrome Posterior tibial insufficiency Adult acquired flatfoot It is a tough choice. Akermark C, Ljungdahl M, Johansson C. Long- term results of fas-ciotomy caused by medial tibial syndromes in athletes. It all takes time to fine-tune and learn where my body finds its sweet spot. Otherwise, you risk injury. So if you plan on racing you may consider that as an option though you wouldnt have time to trial it much so you do run the risk of it causing its own issues. I am not running. So my questions for you are is how bad do you think I made my feet after my injury, also is there a way where aggressive strengthening and supportive shoes can improve my arch and make me more stable while I run? Posterior tibial tendonopathy is a long process and can take months. Best of luck! I really want to heal this injury 100% and get back to normal. HI Jayne. The muscle grows too big for the compartment or sheath that surrounds it increasing pressure within the compartment and causing pain. a good manual based physical therapist can help you with this, but it takes special training. I take some rest and give up running for couple of weeks, but once I return to activity the injury reoccurs. Cannot put weight on foot or do a heel raise again, Advice as to whether I need to seek out an MRI at this point or just keep on the crutches until the pain subsides and I can start doing eccentric exercises again? Dont give up. It is also the . Be sure to properly address it so you dont lose too much time with your training. The new insoles have a high center that takes some pressure off the arch and in less painful. What else should I ask about? 3 pp 482-486, 2 Pomeroy GC, Pike RH, Beals TC, Manoli A. Thank you for your advice. Ive seen a doctor and a PT for advise, and they concur that its most likely some form of PTTD (perhaps without the D). Overpronation can be corrected with orthotic inserts which are placed into the shoes to correct the motion of the foot, which in turn will reduce the load on certain muscles in the lower leg. Abnormalities of all of these structures can be readily seen on MRI and have been demonstrated to occur in association with advanced posterior tibial tendon dysfunction.5,6, Sinus tarsi syndrome is strongly associated with posterior tibial tendon dysfunction and can be an important secondary sign of tendon disease.7 It can also be seen in inflammatory arthropathy, which may or may not co-exist with posterior tibial tendon pathology. During the off time it is important to work through the rehab focusing on calf stretching, ankle and PTT strengthening including the calves and foot muscles. Citation totals as listed on Google Scholar, Creative Commons Attribution 4.0 International License, Syphilis Its early history and Treatment until Penicillin and the Debate on its Origins, Definition of Terrorism Social and Political Effects, Load Carriage: Minimising Soldier Injuries Through Physical Conditioning - A Narrative | It will take effort on your part to get it all arranged but it maybe highly revealing. I have not really been given any answers and I will try anything to get this fixed, can or will I return to full fitness as Its effecting my mental health now, Hi Chris your symptoms and the findings picked up from the MRI are strikingly similar to my current situation. The blue tends to fit most feet, but a variety of options are available for customization. If you have a local running store near by you may check with them to see who the best PT in town is for a quick tune up prior to the race. She said I will acclimate over time. Given the mechanism of injury there maybe something unstable in the ankle causing the overuse or the PTT itself was injured some how and is not fully recovering. I would suggest a very thorough warm up, then a short run to test the area. I printed out a list of my symptoms for her, but you explained much better what is probably going on, so Im not as alarmed. If you have done all the above and not seen much change in your symptoms I would advise having it assessed either by a physical therapist or a sports medicine physician to insure something wasnt missed and to get a more clear picture of the cause of the symptoms. Ive been doing strengthening exercises since then and it is slowly improving, but I am dying to go for a run. I am on week 10 with a boot. Go all in. If the pain does not subside you may need to be in a walking boot to immobilize the area for a while. Posterior shin splints in medical terms is known as medial tibial stress syndrome (MTSS). I had been in so much pain, my only relief was aleve and sleeping remedies. Good Luck and keep us posted on how it all goes. My foot and ankle have been hurting, but I thought it was supposed to help that pain. When I am not running, I have no pain, no swelling, etc. Shin splints are, however, painful, and may indicate that other overuse injuries could develop and that aspects of the individual and/or the training need to be reviewed. from Podiatry Today. I no longer participate in either. Cycling 15 mins also pain free, so encouraging. However, immediately after I stop I can feel it walking. I am back running and the pain appears to be deminishing. If as you progress and taper up the weight the pain continues to bother you for up to 4 days post exercise then you need to seek a medial opinion to be sure you are not missing something. At my last PT visit, I showed where I had bruising and swelling above my ankle bone. Medial Tibial Stress Syndrome Introduction Pain generally in the inner and lower 2/3rds of tibia. Will let you know how it goes!! Hi Ben, my name is Mandy I am running the Boston Marathon in a week and a half and been having issues with posterior tibial tendonitis for quite some time now I would love to write you more about it just checking to see if you would actually write back on here? If you were my client I would have you work on a preventative program to keep your feet, ankles and hips strong and monitor the running surfaces and types of foot wear that work best for you. What can I do? Your body mass will have a direct affect on how the foot functions and how much work it must perform. I have been left in a lot of paim which on researching seems to point to this condition. I thought Id update you with the recent developments. . Improve your balance. My tendons were tight from the start, the pain steadily increased until km 10 and then was static until the end but it radiated up the medial leg, so probably the entire tendon, which I had never experienced before (it was always only my feet). Good Luck! The hard part is how to properly return back to running. I stopped the prior week when the pain developed but this weekend did a 20+ mile run as a final long run before the race. So yes I would be in favor of staring physical therapy again for you. Yes, as the muscular integrity of the foot increases while maintaining good foot mobility you will see improvements in many common foot/ankle related issues from plantar fasciitis to sinus tarsi syndrome and of course PTTD. I also have sharp pains in the L5 area as soon as I put them in my shoe. My feet must always be flat, otherwise my feet/ankles hurt). Hi Butch, Yes it is possible to gain enough strength to help support the navicular and improve the arch. Also at times the pain is in my arch instead of ankle. Also, how does one go about making the right choice of orthotic support? 3. Ive already tried backing off to just easy miles and doing calf raises and foot and ankle exercises with the bands. So be patient, dont give up and during this time dont just focus on the foot/ankle focus on you and your body and making the changes you need to be healthy all around. Clinical features are predominantly of pain over the medial tibia, more pronounced over the distal half, occurring on weight loading of the leg, and resolving on rest. Have my 2nd marathon in late April and am willing to run through slight pain to make this goal. The pain usually comes on during a run and goes away with rest, only to return when training resumes. For instance, the worst has been the upper back pain, right below the base of my neck. These may be felt in the inner ankle, the bottom of the foot and the toes. My hunch is that the noon gun time had something to do with the lack of discomfort since I was thoroughly warm from being up on my feet since 7am. I dont think you need to give up on the dream to run a marathon, you will just have to progress more slowly and be sure to eliminate as many risk factors for PTT as possible. The key is slow and steady. It was amazing. What are the findings and what is your diagnosis? I am already planning on wearing compression socks and KT tape if I attempt the race. Randy I am so sorry to hear about all of this. Best I can say is anticipate 4-6 weeks and let the symptoms guide your treatment are return to activity. I went to see my PT for treatment and made a full recovery. what do you suggest i do? Im a 15 year old girl. My question is how many people have you seen progress from here to complete a marathon comfortably, that is without frankly worrying about the pace/ timing and could you share the link to their success stories if possible. I am okay with taking this slowly again just as I progressed from couch to 10k, without the stupidity of what I did in April. I saw physiotherapist and he said some muscles are not activated on my feet that makes the issue chronic, so he gave me some exercises that focused on tibial area and big toe muscle activation. That is fantastic! The posterior tibialis muscle is a particularly important muscle in runners as it is used in plantar flexing the ankle (pointing the ankle/toes downward) and inverting the ankle (rolling it inward). In my experience you have to treat the actual condition as well as the entire lower chain. ), Also your YouTube channel is great! I hobbled in and walked out tentatively but without limping and foot was at 85%. Im not opting in for the surgery, just proper footwear, insoles, bracing, and resting. I do warn my clients that it is not unusual to experience a mild to moderate amount of discomfort during certain exercises or activities. Prior to that I was having dull pain in my hips for about a month, but could manage through. Luckily, I can work from home and rest as much as needed. Your physician could also prescribe a stronger anti-inflammatory medication if necessary. I am 6ft 4, 175 pounds and have suffered from pain in my Achilles tendon in the past. I have had flat feet since I was a baby . The higher the impact, the worse the pain. This is especially true if your pain becomes gradually worse, as this can lead to long-term or permanent injury to the leg. Definitely address this now before the pain worsens. The results were Advanced tibialis posterior tendinopathy, with interstitial longitudinal partial-thickness tearing/strain, greatest inframalleolar, extending to the navicular. a small retrocalcaneal bursa effusion with mild oedema in kagers fat pad, moderate fluid seen around the tibialis posterior tendon and the extensor digititorum longus tendon consistant with mild tenosynovitis. And yes this will bring more blood flow to the area which should bring in more nutrients and theoretically help it heal faster. I have been referred back to the ankle consultant. Overuse injuries like MTSS can impact up to 70% of runners in a year [1]. I was diagnosed with ptt, sinus tarsi syndrome and heel bursitis. I never believed I could reach the heights of 26.2 until I started listening to the MTA podcast. -Brooke T. After all these years of listening to you guys and having the MTA Community support, to have you now helping me to train is a treat! Have you had a medical professional look at the area? He seem to THINK I have a torn tendon but Im not trying to do any surgery because Im overweight hypertension n diabetic. I will be interested to hear if you decided to run it or not and if so how did it all turn out. I also have custom orthotics being created right now and will soon be wearing them. Cycling is out of the question, as that further worsenes the PF, both in normal and clipless racing shoes. It sounds like you were in a boot a long time, so at this point I would look to try a steroid injection to help limit pain then slowly taper out of the boot while still doing PT. This is likely something you will have to manage by finding the best footwear and appropriate terrain for you. It is in the lower part of my calf, close to where this shin splints were, but it is not on the bone like before. Ben. I go twice a week for an hour. I have a slew of rehab exercises from my PT that Ill wait to resume until next week. What would you advise? Had a boot on for 3 months, I swim 30-45 mins once or twice a week as cannot cycle for longer than 20 mins. 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