This post was written for us by Sam Jeffrey from Active Feet.  After reading some interesting articles on cyclingnews about foot problems with cycling I asked Sam if he could write a post about orthotics for cycling.   Here it is…

Leading to Orthotics…  Biomechanics & Repetition.  Overuse Injuries.

It isn’t uncommon that those who cycle often run as well.  Either as a form of cross training or in conjunction with swimming, as a triathlete.

There is something that draws the cyclist and the runner alike to their chosen passion.  There is something in the repetition and monotony of the act that never gets boring.  Whereas there are those that are drawn to contact sports (or similar skill based endeavors) which will always offer a different experience and outcome every time they are undertaken.

Unfortunately repetition can also be our undoing, in the form of injury.  In the high mileage cyclist, if there is a slight presence of incorrect bio-mechanical patterning, our predisposition to injury is significantly increased, due largely to the high amount of times we repeat this incorrect patterning.

Just about anyone who has purchased a road bike of a reasonable standard from a reputable bike shop would have undergone a bike fit.  This for one thing ensures the bike you are buying is in fact the right size, but many other factors are looked at also:  Stem length, seat height, seat fore/aft position.  The list goes on.

Personally my issue with bike fit is that it is too subjective.  By this I mean that your final position on the bike is often the result and sum of an individual’s personal experiences combined with some proven objective standards and data.  Hence opinions from individual to individual can vary (sometimes significantly), and not to mention what the cyclist themselves actually feels whilst riding the end product.

My point and direction here, is that there is an element of cycling and bio-mechanics which has far fewer variables to take into account and hence the application tends to be more objective and based upon years of clinically proven methods.

Orthotics, do I really need them?

Firstly it is important to note that an unnecessary and unwarranted orthotic will do nothing more than limit performance.  Remember that, like you superlight superfast wheelset, cycling shoes and in turn orthotics are a rotating mass, and will slow you down.  Therefore if there is no pending reason for their implication then perhaps you should be asking some questions.

Some of you may have had orthotics in the past, either prescribed by a podiatrist for your day to day footwear, or for sport shoes and more likely running footwear (or both).  If this is the case, then please note that this doesn’t automatically mean you need an orthotic for your cycling shoes as well.

This is mainly due to the fact that there is a significant reduction in load an impact sustained by the foot and limb from running/walking to that of cycling.  Remember, your foot never touches the ground.  Therefore whilst the most common pathologies in runners and cyclists caused by poor foot and lower limb mechanics are very similar, the distinct lack of impact can create a situation whereby they simply don’t cause a problem whilst cycling.

For example:  You suffer Medial Tibial Stress Syndrome (commonly pain along the lower inside edge of the main shin bone) whilst running.  This is attributed to by internal tibial rotation created by the foot over-pronating (rolling in too much).  This same over-pronation also occurs whilst cycling and therefore the same internal tibial rotation – but there is no pain.  What gives?  The answer:  No impact.  Therefore is the running orthotic designed to remedy this situation required when cycling – No.

My point here is that unless you are experiencing pain or injury whilst cycling without your orthotic, and have been able to sustain this for some time, then you don’t need your orthotic in your cycling shoe.  Don’t make the assumption that orthotics prescribed for one activity automatically apply to all.

So now assuming you are experiencing some pain either in the foot or lower limb/knee.  What do you do first?

Well, before rushing to see your local podiatrist to get an expensive custom orthotic fitted, you need to examine all the obvious variable of the situation.  For example:  Has my mileage been excessive of late?  Is there an obvious flaw in my bike fit (saddle to high or too low)?  Or have I done another activity off the bike (renovated the kitchen) that may have attributed to the pain?  If you have checked all of these boxes as no, and the pain persists past a reasonable period of rest, you may then be in a position to seek the advice of a podiatrist and explore you options here.

What type of pain may I be experiencing to warrant this visit?  The most common complains that may warrant orthotic intervention include:

* Knee pain
* Arch / heel pain
* Pain under the ball of the foot
* Loss of sensation in foot (numbness/tingling)
* Achilles, calf or shin soreness/pain.
* ITB soreness/pain
* Obvious power asymmetries from side to side (possibly contributed to by a leg length discrepancy).

Then, don’t assume just because you are now seeing a podiatrist that they will instantly fit you for orthotics.  A good practitioner will firstly look to diagnose the problem and then dependent on its severity will often trial and error more passive means of treatment first, before opting for the more aggressive, permanent and most importantly expensive orthotic option.  Note the importance here of some form of diagnoses of the problem (which can only be done by a health care practitioner, and more specifically a podiatrist who is a specialist in all things foot, lower limb and knee).

To a degree, it is important to note that treatment for any injury (but especially when treating with orthotics) can require a trial and error approach.  It is therefore also important that you have faith in your practitioner, and understand that the orthotic device, if implemented, may require several subtle (but significantly influential adjustments) before it starts to work and feel good.

Passive means of treatment leading up to orthotic intervention may include stretching strengthening work, massage / ultrasound from a physiotherapist, and taping to change the biomechanics of the foot and lower limb/knee.  A good podiatrist will only implement an orthotic if he/she feels that you will get improvement from this and will therefore often trial these afore mentioned methods first.

Ok, so I need orthotics.  What does this involve?

Assuming you now require an orthotic, note that orthotics for cycling shoes are not as common as those made for weight bearing activities.  Firstly in normal running and walking gait, it is the heel that generally makes contact with the ground first.  Therefore orthotics are often based around controlling varying degrees of motion at this first point of contact.  In turn, a cyclist will more prominently rely on forefoot loading and therefore orthotics can vary quite significantly in design because of this main biomechanical difference.

The other major considerations are the size, weight and materials used to make the orthotics from that of weight bearing to cycling.

A cycling shoe in terms of depth often allows very little movement internally in order to optimise power transfer into the pedal and the crank, both when pushing but more so pulling the pedal with the hamstring. Therefore, because of this limited space, if the orthotic is not based around a cycling shoe to some degree is simply won’t fit the foot in there as well, often leading to numbness and general discomfort.

Weight and materials go hand in hand.  Harder materials will generally offer more correctional ability than softer ones, however with Density comes weight (and sometimes discomfort)…and as every true cyclist will tell you “it’s all about the weight!”  It’s therefore up to the skill of the individual podiatrist to prescribe the required combination of correction and weight in order to achieve a sustainable result.

If your thinking you may fall into the category of needing an orthotic for cycling, it is quite possible that your current shoes may be ok for this, but also be prepared to change if the end result is worth the outlay in respect to working better with the prescribed orthotic.  Also be open to the fact that it may actually be the shoe itself causing the problem, but that’s a completely different post…

Active Feet is a podiatry footwear store that specialise in running and day to day footwear (not cycling shoes), and a video treadmill gait evaluation is provided free of charge to analyse barefoot running/walking gait and in turn recommend and test shoes.  Orthotics are handled by their clinic.

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