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Velo-City: Perth » Salvation for the aching sole

Salvation for the aching sole


A pain in the foot isn’t the first thing you associate with hours on the bike but it’s very common, according to one researcher.

Hayley Uden, from the Podiatry Department at the University of South Australia, said there was very little published research about foot pain in cycling but she was coming across the problem frequently in her clinical practice and also in her recreational riding.
“The more cyclists I spoke with, the more common this experience seemed to be, so I decided to explore it further,” said Hayley.

She ran an online survey of South Australian recreational cyclists and 71.3% of the respondents were male and 28.7% were female. More than half of them had experienced foot pain while cycling.

“People who rode more than 51kms per week using cleats were the most likely to suffer from foot pain,” said Hayley. “The most common problems were Achilles tendonitis, plantar fasciitis and metatarsalgia.”

Achilles tendonitis
The Achilles tendon is the largest and strongest tendon in the body and transmits the force of the calf muscles, particularly during climbing. Riding with a slow cadence in a high gear; with the seat too low; and with too much dorsiflexion (pushing your toes upwards and heels down) can result in small tears in the tendon especially just above the heel where the blood supply is least efficient. The back of the heel becomes extremely painful and can feel like a rusty old nail is being driven through it.

Plantar fasciitis
Like Achilles tendonitis this is an overuse injury and is common in both runners and cyclists. When the plantar fascia, a fairly inflexible band of tissue running under the foot, is being continually stretched you end up with inflammation, irritation and pain at the attachment of the fascia into the heel bone. It can produce the same “rusty nail” pain as Achilles tendonitis although with plantar fasciitis it is characteristically at its worst when you get out of bed in the morning and then improves during the day. The pain will be felt under the foot, in the arch area, or at the back of the heel.

Both Achilles tendonitis and plantar fasciitis are relatively easy to trigger and notoriously difficult to shake off, so prevention is definitely better than cure. It’s important to get them correctly diagnosed as the treatments differ. However for both these injuries rest or reduction of work, post exercise ice, non-steroidal anti-inflammatory drugs and gentle stretches will help. Plantar fasciitis often responds well if you stand on a ball or bottle of iced water and roll it under the foot

Metatarsalgia
This common complaint among cyclists is sometimes ambiguously referred to as “hot foot”. It can be chronic, but often its appearance seems random – one day you have it the next you don’t. The burning and numb feeling that occurs on the sole of the foot, in the area just before the toe joints begin, is caused by compression of the nerves that run to the toes. This compression can be the result of an ill-fitting shoe or foot pronation inside the shoe, putting pressure on the nerves. Sometimes it might just be that you are riding further or in hotter temperatures than usual, so your feet swell and when you return to your normal routine, the problem disappears. Whatever the cause, the solution is – theoretically – simple: give the feet more room so the nerves aren’t squashed. You just have to work out whether this means a larger shoe, or a different foot position in the shoe. Some shoes actually have a “metatarsal button”, a small raised area just behind the ball of the foot, that spreads the metatarsal heads apart and gives the nerves more room as they pass between the bones. For riders who haven’t been using cycle-specific shoes, just changing to a shoe with a stiffer sole, which spreads the pressure, can bring relief.
Of course the flip side of “hot foot” would be cold foot, and you can end up with numb, painful feet in winter simply because they are cold. This is a perennial problem for cyclists and various remedies have been suggested, including covering the toes with plastic wrap or alfoil, layering socks and using chemically heated pads in the shoes. You can try periodically pulling up on the pedal stroke to lift your foot inside the shoe and relieve pressure on the soles, allowing warm blood to circulate. Do this for just a few strokes. If things get really bad, you might find that getting off the bike and walking for a minute or two will also change the pressure and get the circulation going – especially if you walk straight into the nearest warm café.

In theory foot pain should be easy to manage, since there are only two possible sources of the problem- the rider or the equipment – but this is where it gets more complicated.

Ian Wee, an occupational therapist specialising in musculoskeletal injuries at the Perth Integrated Health Clinic, treats a diverse clientele including children, older riders, recreational cyclists and professional athletes.

Ian firstly analyses the rider’s position on the bike. In the optimum position, the front surface of the pedal should be at the ball of the foot and the foot should be slightly turned in, creating a slight taper of the knee, which in turn keeps the hips straight. If you draw lines forward from the kneecaps, they should converge about two metres in front of the bike.

“Because these problems tend to be multi-factorial, rather than having a single cause I also look at what else is going on in the person’s life,” said Ian. “How are they sleeping, how much time do they spend sitting at a computer, what other types of exercise are they doing, and so on. They all have an effect.”

The cleating commitment
Attaching the shoes to the pedals can increase a cyclist’s power on the downstroke and harness additional power on the upstroke. Usually this is done with toe clips and straps, or with shoes having a cleat, a small plastic or metal device which easily attaches to and detaches from the pedal. According to Darryl Benson, Head Coach of Cycling at the Western Australian Institute of Sport, correct cleat positioning is a key part of comfort on the bike.
“There’s plenty of debate over the ideal position of the foot in relation to the pedal, but you have to always take into account the biomechanics of the individual athlete. I have some lower back issues, so I have my right foot dead straight and my left slightly in because that works best for me.
“Generally, having the ball of the foot over the centre of the axle is a safe set up, but you also need to have a lateral arc that allows optimal foot alignment to the pedal,” said Darryl.
Once you clip into your pedals, the path that your leg “tracks” during the pedal stroke is locked in, and misaligned cleats send stress from your foot up your leg to your lower back with every pedal stroke. The side to side adjustment or arc tends to be a matter of personal preference.
“Most cleats now have a certain amount of float, or lateral movement,” said Darryl, “which is important, unless you are trying to eliminate bad habits. For example, pigeon-toed people will ride heel out so you might set the cleats to not arc out too far or they exacerbate the problem.”
If the shoe fits …
Darryl said that the other important element for comfortable riding was the right choice of shoe, and that doesn’t mean copying the footwear of your favourite Tour de France rider.
“Aussies tend to spend a lot more time in bare feet or wearing thongs, so we have wider feet than the average European. Although the top brands of shoes are probably better quality, they may not be the best choice for people with broader feet,” he said.
Once you’ve got your shoes, there are a couple of things you can do to avoid foot problems.
Shoe adjustment
Ian Wee advises that when you tighten road shoes, you should do up the uppermost buckle or strap first, then the one below and then the toe strap last, as this puts the foot in the most symmetrical position. If the foot moves unevenly in the shoe, it creates unnatural forces which can lead to numbness. Remember that in the hot weather feet will expand, so bear in mind that the laces or straps which have been adjusted to suit the foot at starting temperature may need to be re-adjusted mid-ride.
Orthotics
Sometimes orthotics, in the form of shims (wedges between the outer sole and the cleat) and insoles are prescribed for foot pain but there is some debate about their effectiveness.
Ian said that he tends to encourage clients to get out of shims and into insoles.
“The power stroke and transference of force comes from the arch of the foot, not from the shim outside the shoe, so we’re working on supporting the arch,” he said.
Shims are often prescribed to correct uneven leg lengths, but their critics argue that the wedges can exacerbate the injury. For example if you have a misalignment of the pelvis, this can look like a leg length discrepancy and when a wedge is applied to “correct” the discrepancy it can actually make you over-flatten or arch your foot to compensate and result in injury. In this case, working on core stability exercises to re-align the pelvis could be a more effective solution.
The important thing is that we need to listen to our bodies and be guided by what suits them, not get caught up in fads, whether it is for mileage or shoe brands. If you do fall prey to foot pain, get an accurate diagnosis so that you can be pedalling pain free in the shortest possible time.

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