Secrets To Treating Bicycling Injuries

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

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.

What Causes Overuse Injuries And How To Treat Them

   More often than not, iliotibial band syndrome is the result of over-training, a tight iliotibial band, varus alignment of the lower extremity, internal tibial torsion, overpronation or incorrect seat height. It is often accompanied by trochanteric bursitis and is characterized by pain and point tenderness over the greater trochanter. Iliotibial band syndrome can also produce symptoms at the knee joint or its insertion site on the tibia. Management of this condition consists of iliotibial band stretching, ice massage, nonsteroidal antiinflammatory drugs, orthoses and cleat and/or saddle adjustment (see “Recommended Bike Adjustments For Common Overuse Injuries” below).

   Patella femoral pain, chondromalacia and infrapatella tendinitis are common problems in cyclists. Patella femoral pain is often referred to as biker’s knee and is associated with patella malalignment, increased Q angle, valgus foot and leg alignment, overpronation, a saddle that is too low or forward, poor cleat adjustment or alignment. Treatment includes correcting the mechanical factors related to the bicycle; improving foot alignment with foot orthoses or medial wedging between the shoe and cleat; and ensuring proper stretching of the vastus medialis.

   Patella tendinitis presents with pain at the proximal or distal pole of the patella that increases with the extension of the knee, especially against resistance. The mechanical factors usually associated with patella tendinitis are incorrect seat height and improper saddle fitting. This condition can also result from valgus leg alignment, internal tibial torsion and overpronation while pedaling.

   In addition to correcting the mechanical and foot/leg alignment factors, cyclists should decrease the intensity of rides and the resistance they are pedaling against by using lower gears and higher cadence until decreased symptoms permit a return to increased training.
Achilles tendinitis and plantar fasciitis are overuse injuries that can be caused by training errors or riding with the seat height too low. Biomechanical conditions contributing to
   these injuries include overpronation and a leg length discrepancy. Plantar fasciitis may also be caused by old or worn out biking shoes. The shank or rigid sole of the biking shoe becomes more pliable, causing excessive flex in the shoe and strain on the plantar fascia.

   Achilles tendinitis is marked by pain in the Achilles tendon and occasionally the insertion. Patients have increased pain when toeing off or standing on their toes and pedaling. Plantar fasciitis usually presents with pain at the plantar fascia insertion of the medial calcaneus.

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