Paging Dr. Germ!
haha just had to say it.
I have more questions for the patient! If you prefer to respond to me in PM that is fine.
How old are you?
Any history of injury to the ankle joint, sprains included (even if decades ago).
Any injury history to the tibia or fibula, or shin splints. As with many of these hard-to-figure squishy part problems (hello Dan! Squishy parts!!) rule of thumb is too look ‘further away’ from the point of pain for a root cause. Take the tibialis posterior muscle for example. If you have a collapsed arch, or adult onset flat feet, the tibialis posterior muscle aids in maintining the middle longitudinal arch as well as havning a function with plantar and dorsiflexion. This muscle terminates distally as the PT tendon attaches to the talus.
Have you lost 50+ pounds or more over time
How would you classify your feet, ie, flatfoot, high arch, pes cavus, or?? Photos most helpful, especially photos from behind in bare feet on hard surface.
How would you describe your lower leg bones: “bowlegged”? What is the angle of your tib/fib coming ‘out’ of the ankle joint (especially when on the bike, on the back part of the stroke, 10-11 o’clock.
PTTD is the end result of a long time of dysfunctions, and in regards messing around with cleat placement and saddle height, these accomodations are just that, accomodations, and will not solve the problem. If you’ve not had Xrays I think you should.
I’m thinking possibly that you have a talus fracture, or a talus lesion - possibly from rearfooot valgus.
Also to address comment about Speedplay “promote rotaion not only medial and laterally but also vertically inward and outward. Sort of pronation on a bike.” This is not an accurate statement of a properly maintained Speedplay pedal, ie, they do not operate this way ‘out of the box’. However, the lateral edges of the ‘lollipop’ can be ground down over time, and the pedal body should be replaced. Foir the most part this takes years - depending on rider weight and mileage. I have also observed baseplates get divots in them, due to a variety of factors, this too can lead to a ‘wobbly’ or off-cant sensation.