I've been battling posterior tibial tendonitis (actually tendonosis if you want to get technical) for a while. My doctor (also a triathlete) suggested a few courses of EPAT therapy. This seemed to promote blood flow to the area and perhaps speed the healing a little bit. Otherwise, it's all the stuff you already mentioned. I'm surprised they put you on anti-inflammatories. They're OK for pain management, but my understanding is that they actually slow the healing process significantly. If you're not trying to run and the pain is bearable, I'd think it would actually heal more quickly without the NSAID's. Check with your Dr. on this.

For me:
cycling = yes
elliptical = yes
Never walking around bare footed (got a pair of Oofos sandals for when I'm not in regular shoes, which always have my custom orthotics in them)
Icing = yes, a few times a day.

What made this a LOT more bearable was using an AnkleAid. It's ridiculously expensive for what is essentially a plastic tub, but having your toes out of the water makes icing your ankle a lot more bearable. I can easily do a 20 min. ice bath with this, whereas if my toes are in the ice water I can't go 5 minutes. Also, an ice bath is going to be a lot more effective than one of those cold wraps. Good luck!

Get a Bosu ball and just balance on one foot with it. Strengthen muscles around the ankle.

NCAID's do help, but over a long period you can get some side effects from them. Not that 10days is long, but inflammation can take very very long. Besides exercises and Diflofenac, you can try some "natural" supplements as well for the time beging. For example green lipped mussel has shown in several studies to be almost as anti-inflammatory as NCAID's. Turmeric seems to help as well. Ginger a little also. And omega3.

I am far from a hippy, but it's worth the shot. Helps me better than NCAID's did. It at least has no to hardly side effects and half of them you could buy in the supermarket (like omega-3 rich fish and ginger).

Well after an Ultrasound today 4 weeks out from my Nice Ironman, I have Ankle tendinitis, luckily there's no rupture. Been given anti inflammatory for 10 day course. No running Doc says till he see's me at the end of this course. I can still cycle and swim as there's no pain, sometimes a little with cycling though not often. Things haven't been right for past 3 weeks after RICE no improvement as such. Cause overuse and wearing wrong shoes for a period, as I'm flat footed but not in a bad way.

Doc says I can do the Ironman run (Sports Doctor) try to run on the midfoot as much as possible he said.

He's told me in the meantime to exchange running with Aqua running, very boring he goes, but an alternate.

Any suggestions out there....

Why did he suggest you do a mid-foot strike? Was he trying to unload the achilles with that?

I have had several bouts of severe ankle tendinitis over the years, and here's what's worked for me:

1. Ultrasound therapy. Which means a trip to the PT's office, to get your ankle buzzed with sound waves and then humor them to do a bunch of strengthening exercises
2. Strengthening exercises. Alphabets, towel scrunches, resistance band flexion, etc
3. Alternating jacuzzi/ice therapy post-workout. That was the first time I could see the visible puffiness on the tendon abate after a run.
4. Run/walk pattern to break up the high impact on the road. I had to start back easy on the run, like 0:30/1:00 run/walk. If it's at the point when you run that you can't make it through a mile at a time, I'd start thinking about triage on the run leg of IM and practicing for it now.

Good luck. It's not fun and the only real cure for it is rest, which I hope you can do a lot of after IM.

What do you think triggered it?

My first line of defense is to increase your cadence. I do not like taking rest for these because it does not address the problem of what led to overload in the first place.

If you take 2 weeks off and the symptoms go away, that does not mean the problem is gone. Most often it comes right back when you run. Have you had your running gait recorded?