After Orthodics, what do you recommend for possible PTTD?

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44YO Athletic male 6'1" 185 pounds. No health issues. Used to run 5 miles per day since 16 YO and always had "flatter than normal" feet but no problems other than chronic shin splints. Wore good running shoes throughout. Shin splints forced me to run on a treadmill starting in 1995.

Jan 06 MRI confirms right ankle talus bone density and cartlidge damage above density in ankle joint. May 06 orthopedic surgeon successfully fixes right ankle but no more high impact exercises and must wear orthodics all the time with laced shoes. Post surgery no weight on ankle for 3 months followed by PT until full strength retruned. Started rowing and religiously wear orthodics with correct running shoes / laced dress shoes when not sleeping. No high impact or heavy lifting.

NOV 06 orthopedic surgeon confirms left foot PTT swelling and arch flattening with left foot pronating more than before.

CURRENTLY have increasing and more constant pain in left PTT from above ankle well into the arch. Left foot pronation is worse and ankle joint from front appears to be off center of foot and rolling to arch side. Motrin ineffective. Both feet now 2 sizes bigger (11 >> 13) in the last 3 years. I still wear orthodics religiously and have had them adjusted / renewed yearly since I started wearing them in early 2006. Right foot arch sore but not as bad as left.

What is your recommendation for what to do next? I would like to avoid surgery but understand it may be inevitable. I really would like to alleviate the pain entirely and be able to walk all day without my feet hurting for days afterwards.

Appreciate any recommendations you might have.

Brian