Secrets To Treating Bicycling Injuries

By Mark A. Caselli, DPM, Edward C. Rzonca, DPM and John J. Rainieri, DPM

How The Right Cycling Shoes Benefit Patients

   For the casual rider who does not have any known foot problems, cross-training shoes provide the necessary support across the arch and instep in a shoe that can be used for other purposes. They also provide the heel lift that cycling shoes give. Cyclists who are a bit more serious about the sport will frequently buy bicycle touring shoes. The touring shoe’s stiff sole protects the foot from the pedal and is somewhat more efficient in transmitting force to the pedal. However, one may also use this shoe for walking.    Cleated cycling shoes are made specifically for bicycle riding. The cleat on the bottom of a cycling shoe secures the foot to the pedal, allowing the cyclist to pull back the foot forcefully during the recovery phase as well as push down during the power phase without fear that the foot will come off the pedal. The traditional cleat has a groove underneath in which a portion of the pedal sits. The strap of the toe clip holds the groove of the cleat on the pedal. The strapless cleats and pedal systems secure the foot to the pedal in a similar manner to ski boot binding systems. Some strapless systems allow transverse plane motion.    A cleated cycling shoe has a rigid plastic, wood or leather sole to prevent the cleat from being torn away from the sole and to protect the cyclist’s foot from the pedal. Another advantage to a rigid sole cycling shoe is that it will not twist as much as a recreational shoe. If the foot has a tendency to roll inward with pronation, the sole of the firmer shoe will not twist with the foot, facilitating foot stability.    Wedging is one shoe modification that can help realign the lower extremity during the pedal cycle. The wedges are generally varus in nature and one can usually apply them to the sole or inside of the front of the shoe.    Some cleated cycling shoes have a forefoot valgus wedge built into the sole that will tilt the lower extremity closer to the bicycle. This creates a more aerodynamic position but can create biomechanical problems for many cyclists. When examining the shoe, the sports clinician should always set the shoe down on the counter edge as if the cleat were on the pedal and check that the bottom of the front of the shoe is parallel to the edge of the table.    European companies make many shoes over lasts designed for the narrower European foot. When cyclists have complaints that may be caused by excessive compression, the sports specialist should check the cyclist’s shoes first.

Can Orthotic Modifications Have An Impact?

   Ideally, the foot orthosis for cycling should be as rigid as possible in order to have the greatest influence on the foot. Foot orthoses for the cyclist help reduce misalignment of the overly pronated foot. One should employ an intrinsic forefoot post because it takes up less room in the shoe. The forefoot post should accommodate the forefoot and rearfoot (subtalar and tibia) varum components one observes when the cyclist is in the angle and base of cycling. If the cyclist has extensive rearfoot varus, one should wedge the shoe to accommodate the tibial component and use the foot orthosis to accommodate the subtalar component.    In many instances, it is advisable to add a forefoot extension to the orthotic. In regard to the forefoot extension, one may use a soft material to provide cushioning if it does not make the shoes too tight. The forefoot extension can also have a wedge shape. The varus wedge is almost always the appropriate choice. In addition to helping align the leg by bringing the shoe up to the foot, the varus wedge can distribute the force more evenly across the forefoot. Distributing force over a larger surface area of the foot reduces compression.

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