Foot Pain

newsletter

Cronometro is a bike shop in southern Wisconsin specializing in bike fit and has partnered with Physical Therapists Stacey Brickson and Heather Hartwig Stokes to offer you a comprehensive approach to minimizing injury and maximizing performance on the bike.

footDon’t let the white stuff on the ground discourage you.  Cycling season isn’t far away, and now is the time to make sure your fitness and bike fit are primed so that you can hit the pavement rolling pain free.

Foot pain is a common complaint among cyclists and the topic of this newsletter.

 


 

Anatomy and Biomechanics 101

feet_diag1Those are big shoes to fill.  There are 26 bones in the foot and ankle, 33 joints and over 100 muscles, tendons and ligaments. A quarter of the bones in the body are accounted for in both feet.  It’s no wonder we notice when they hurt. The foot can be broken down into “3 foots”: hindfoot, midfoot and forefoot. The hindfoot consists of the calcaneus (heel) and talus (ankle). The midfoot has 5 irregularly shaped tarsal bones. The forefoot is occupied by 5 long metatarsals and their respective toes (phalanges).  A few sesamoid bones exist which don’t get a lot of press.

feet_diag2The tarsals and metatarsals form the concave longitudinal medial and lateral arches and transverse arch. This triangle acts like a truss. Stretch tension of the plantar fascia, a thick band of connective tissue running from the calcaneus to the metatarsal heads prevents collapse of the truss. The foot is rich with blood vessels and nerves, so collapse of the arch would be a hot mess, or a hot spot.

feet_diag3The biomechanics of the foot and ankle are complex. Terms that get tossed around fairly frequently are supination and pronation. These are tri-planar motions involving more than one joint. Supination is a combination plantarflexion at the ankle, adduction of the hindfoot, inversion of the forefoot, and medial arch elevation. Pronation is a combination of ankle dorsiflexion, hindfoot abduction, forefoot eversion and depression of the medial arch.

feet_diag4The biomechanics of the foot are designed to accommodate the phases of gait:  heel contact, weight acceptance, mid-stance, push-off and propulsion, and toe-off.  Upon heel strike, the foot is locked in a rigid configuration for maximal stability.  This position is referred to as supination.  During weight acceptance, the foot unlocks such that maximal shock absorption can be achieved.  This position is called pronation.  From mid-stance through toe-off, the foot returns to a supinated position, creating a rigid lever from which to propel the body forward. Runners are acutely aware of this, and often seek foot ware to best meet their individual biomechanical needs.  Cyclists should put proper foot position on their radar, too. More about this later, but for now, appreciate that the foot was designed to walk and run, not necessarily to bike.


 

Metatarsalgia

Hot spot is a common name for metatarsalgia.  “Algia” is derived from the Greek word, algos, meaning pain.  Cleverly named, metatarsalgia is pain caused from compression of the blood vessels and nerves as they run through the tarsal and metatarsal arches.

There may be one or several contributing factors to metatarsalgia.  The most common cause for irritation of the neurovascular structures is poor support of either arch. Flimsy insoles are common in cycling shoes, even some of the really expensive ones.  Cycling is a non-impact activity but repetitive revolutions for hours upon end can certainly tax our feet. Per our previous anatomy discussion, feet were engineered specifically for walking and running, not cycling or swimming. While most swimmers realize that webbed toes and excessive plantarflexion would optimize transportation in an aqueous environment, the inherent limitations of the foot during cycling are less obvious. While cycling is non-impact, the risk for maladies is increased due to the fact that the foot is constrained and remains in the mid-stance position which lacks inherent stability.  In mid-stance position, the foot is well equipped to absorb load and accommodate uneven terrain because in confers the greatest amount of mobility. Great for running, not such a great design for biking. Cycling demands a rigid level to transmit power economically through the pedal.

Cronometro Feet Solutions

IMG_0568The solution: inserts, preferably with constructed with a stiff material, such as carbon fiber.  Cronometro sells three versions of this.
IMG_0578The basic “off the shelf” insole is $50 and is a huge improvement over any insole provided by shoe manufacturers.
IMG_0574The next step is the “Flash Fit” molded insole at $90. This is quickly heat molded to conform to the cyclists foot and also features a nice Metatarsal bump.
 IMG_0566Fully custom formed insoles will conform to the widest variety of foot shapes.

We take an impression of your feet in a vacum form and then mold the insole directly to your foot shape. This process takes about half and hour and costs $120 including the insole.

How Bike Fit and PT Fit Together

The benefit of arch support is ubiquitous.  The need for wedging, however, is not.  The structure of the forefoot and hindfoot and be described as neutral, varus or valgus.  A Physical Therapist can evaluate the structure of your foot, and work with a bike fitter to optimize the wedging in your cycling shoe.  Custom orthotics may reduce the risk of injury in cyclists by altering biomechanics including tibial internal rotation and knee position during the power phase of the pedal cycle (see review by Yeo and Bonanno, Journal of Foot and Ankle Research, 2014). The same wedge won’t be effective for everyone.  The operative word is custom. Be aware that some shoe manufacturers have forefoot varus wedges built into the shoe bed.  This can create problems for the unsuspecting cycling without forefoot varus (I learned this the hard way).

Cleat placement is another factor to consider in metatarsalgia, and is a critical component of bike fit to minimize the risk of injury. Since the foot is constrained with clipless pedal systems, biomechanics up the chain, especially at the knee, are driven by foot position. Just as wedging needs to be customized for specific foot biomechanics, so does cleat placement.  Some riders instinctively move their cleat placement back a few millimeters to alleviate hot spots.  Not a bad idea, so long as you appreciate that seat placement may need to follow suit for the rest of your biomechanics to remain apropos.

Other factors that are likely to increase the pressure on the neurovascular structures include riding in extreme heat, prolonged rides, long climbs or pushing big gears.  Many of these things cannot be avoided.  However, you can take some steps to mitigate the compression.  Namely, be sure your shoes fit correctly. Remember Goldilocks and her porridge dilemma: too hot, too cold and finally, just right?  Shoes come in the same three flavors.  Shoes which are too small create unnecessary compression.  Shoes that are too roomy add demands on your foot muscles for stability, which can in turn create an unhappy environment for the nerves and blood vessels while in a state of constant contraction. I made the rookie mistake of replacing my SiDi shoes without paying attention to the male versus female model.  Little did I know that my SiDi size 42 were men’s, and when I purchased size 42 online, I ordered women’s.  Hello narrow toe box and metatarsalgia.   Lastly, don’t underestimate the power of the toe wiggle maneuver.

In summary, run through the following checklist if you are running hot:

  • Adequate arch support.  Cronometro has 3 varieties of insoles to try.
  • Stabilize the foot with wedges when appropriate.  CronoPT can analyze your foot biomechanics and work with Colin during your bike fit to optimize stability.
  • Cleat position.  We offer cleat fit sessions at Cronometro.
  • Good shoe fit, mindful of cadence and practice the toe wiggle maneuver

Have fun out there!


 

Contact us at Cronometro and Crono PT to keep you rolling pain free.

Fit the Body. Fit the Bike.  Fit Both.

Appointments can be made online at CronoPT or email to schedule:

Heather      Heather.CronoPT@gmail.com

Stacey        Stacey.CronoPT@gmail.com