In every sport, gains in performance are highly sought after. In cycling, these gains in performance are paramount as the smallest of improvements can make a crucial difference in the overall result. Consider Orica-GreenEdge losing the 2013 World TTT championships to Omega Pharma-QuickStep by 0.81 seconds or Mark Cavendish beating Heinrich Haussler by a tyre’s width at the 2009 Milan-San Remo.

Accordingly, cyclists, coaches and sport scientists seek performance gains of any magnitude. This is epitomised by Team Sky’s philosophy of “the aggregation of marginal gains”, where every small performance gain is pursued and accumulated to achieve a large gain.

Many cyclists, whether a club rider or a Tour de France stage winner, will be familiar with using a variety of interventions, such as the consumption of nutritional supplements, employing various training protocols, using lighter and more aerodynamic components or even taking ergogenic substances, to go faster and harder to achieve better results.

The use of foot orthoses, in-shoe wedges and shims are a few such interventions that are believed to lead to an increase in power output and cycling performance. Additionally, they have been advocated to achieve a variety of goals, such as increasing comfort levels and injury prevention.

These devices are believed to work by improving biomechanical alignment of the lower leg and foot, leading to a more linear cycling motion. This may be achieved by limiting mobility, and hence movement, of the foot in the shoe. It is also believed that foot orthoses help spread pressures under the foot by contouring it, which may help in preventing hot spots and numb toes.

As part of a study looking at the effects of foot orthoses on cycling sprint performance, my co-author Daniel Bonanno and I did a systematic review of the current evidence on the effects of foot orthoses, in-shoe wedges and shims during cycling and published our findings in the Journal of Foot and Ankle Research. The aim of the review was to systematically collect all published research studies on this topic, critically evaluate the methodology and summarise the findings.

In brief, there is some evidence that foot orthoses increase contact area under the foot, that they increase pressures under the big toe, but that they provide no gains in power output. Despite the advocacy of foot orthoses being used to manage overuse knee injuries, alter lower limb biomechanics, and improve cycling performance, there is currently no evidence supporting these claims. There is also no current evidence to support the use of foot orthoses in modulating pressures under the foot and to increase comfort levels.

Additionally, a popular practice of using forefoot varus in-shoe wedges (that is, in-shoe wedges for people whose first metatarsal head — the long bones in the foot — is higher than the fifth metatarsal head) has been shown to have no significant effect on maximal power output in a small population of individuals with varying degrees of this presentation.

It is important to note that the findings of the review should be considered with some caution due to the low to moderate quality of the included research studies, such as the lack of participant blinding and using untrained cyclists as participants. It is highly possible that the results of these studies are adversely affected by these factors.

To address the lack of high quality research in cycling, we are in the midst of publishing a research study looking at the effects of foot orthoses on cycling performance. Along with Dr David Rouffet, an exercise physiologist from Victoria University, we have recruited a population of 24 competitive cyclists and prescribed them with custom-made foot orthoses before assessing their sprint power output using a validated sprint protocol.

We hope the results of our study will better inform cyclists about the popular use of foot orthoses during cycling. We’ll keep you posted.

Click here to read abstract and full text of the paper. This literature review was published as:

Yeo and Bonanno: The effect of foot orthoses and in-shoe wedges during cycling: a systematic review. Journal of Foot and Ankle Research 2014 7:31.

About the author

Boon Kiak Yeo is an Honours research student in Podiatry at La Trobe University, Bundoora, Victoria. He is an avid cyclist and competed with the African Wildlife Safaris cycling team for two seasons in the NRS. He is now a podiatrist at Khoo Teck Phuat Hospital in Singapore.

This study was co-authored with Daniel Bonanno, a lecturer and researcher from the Podiatry department at La Trobe University, Bundoora, Victoria. He is a consultant podiatrist for the Carlton Football Club (AFL) and Melbourne City Football Club (A-league).