Tools and Techniques for Addressing Foot Pain or Discomfort While Cycling

If your feet are either valgus or varus, they do not sit flush to your shoes, which can induce muscle fatigue. This can lead to foot pain in the metatarsals, or sesamoids, the delicate tendons that make up the ball and inner area of the foot.
Illustration by Lisa Eriksson

In their relaxed state, the feet will tend to either tilt with the big toe higher up (varus) or tilt with the little toe higher up (valgus). When the bicycle is sitting upright, the pedals, cleats and shoes are parallel to the ground. However, if your feet are either valgus or varus, they do not sit flush to your shoes, which can induce muscle fatigue, causing the arch to collapse. This can lead to forefoot pain in the metatarsals, or sesamoids, the delicate tendons that make up the ball and inner area of the foot. Wedges can ‘fill-in-the-gap’ which is essential for cyclists with extreme valgus or varus feet.

Correcting the Varus and Valgus Among Us

Here’s an exercise which will demonstrate the issue. Imagine you have an extreme varus right foot (the little toe is closer to the floor). Make sure you are on a hard floor, cement or tile, with your cycling shoes on. Place your foot in an extreme varus position. If you have varus feet, this would be ‘normal’ position, in other words, the relaxed state your body wants to return to. Simulate pedaling pressure on the foot by moving the ball of the big toe (1st Metatarsal) down, while keeping the outer side of your foot firmly planted on the floor. If you were on the bike, your foot would remain in this ‘pushing’ position until about 6 o’clock when you start to transition to the upstroke. With this reduced pressure, your foot will want to return to a varus position inside the shoe until about 12 o’clock where you transition to pushing again. When you start pushing, you will again flatten out the foot against the bottom of the shoe. To simulate normal pedaling cadence, rock along the right side of foot from flat to varus. Faster and faster, 1-1/2 times per second – which is a cadence of 90 RPM. Now, do this for 10,800 times (a typical 2-hour ride). You’ll notice the pressure of the 5th metatarsal against the hard carbon of the inside of the shoe, and after a short period of time, the subtle pain of a fatigued metatarsal.

PRO TIP – A fix for this is to use 1-2 wedges that, when placed correctly between the sole of the shoe and the cleat, will rotate the shoe into a varus position as well. Now, in your ‘relaxed’ state, all metatarsals should be in contact with the bottom of the shoe instead of just the 5th metatarsal. I hope this makes sense. Also, if you are using those floppy insoles that come with most cycling shoes, throw them out and get a good insole that will support your arches better. I recommend a supportive insole like the one produced by ICEBUG.

Wedges can also be used to align-the-knee. Here’s a little experiment you can do to see how wedges impact knee alignment. While seated, start with your feet flat on the floor, make sure your thighs are straight out in front of you and your knees are at 90°. Take your right foot and create a varus condition. In other words, raise the ball of your big toe. What happened to your right knee? It rotated outward. Now, create a valgus condition by raising your little toe. What happened to your knee now? It dove inward.

The Failing of Relying on Wedges

I recently had two clients visit me after going to a Local Bike Shop for a bike fit. Both complained of newly created knee and hip pain. Since both had gone to the same LBS, both told me the same story. They said, “The bike fitter had noticed my knees were turning outwards at the top of the pedal stroke, so he placed wedges under my shoes and sold me custom insoles which had wedges built into the forefoot as well as the heel cups. Even though my knees are now straight, they both really hurt.” The theory here is that if cyclists’ knees go outward on the way up, wedges are used to create an artificial valgus condition which rotates the knee inward. A lot of fitters use this second role to align the knees. Even though your knees are now going straight up and down, this is not a natural position for you. I completely disagree with this use of wedges and use an entirely different approach to address this condition.

Let the Q-Factor Be With You

The Q Factor of a bicycle is the distance between the pedal attachment points on the crank arms, when measured parallel to the bottom bracket axle.

The width of the outside of the crank-arms is called Q-factor and is determined by the specs of your crank-arms. When clipped into the pedals that are mounted to these crankarms, your hips are at a constant width determined by the Q-factor. If your hips are wider than your feet, your knees will follow your hips while pedaling up and will follow your feet on the way down. The narrower your feet, the more knee movement you can expect. In my experience, a better method is to align the feet under the hips and only use wedges to treat a valgus or varus condition. This is accomplished by widening the pedal stance, or Q-Factor. There are several ways to do this…

  • Pedals – Several manufacturers make pedals with different axle lengths. Shimano has both a standard width as well as a +4mm (0.1575”) width in their Dura-Ace and Ultegra pedals. Speedplay has gone one better with their Zero Stainless Pedals. The Zero’s are offered in 5 different axle lengths of 50mm (1.9685”), 56mm (2.2047”), 59mm (2.3228”), 65mm (2.5591”) and the stock 53mm (2.0866”).
  • Pedal Washers/Extenders – There are also 1.2mm (0.0472”) pedal washers. Make sure to only use a maximum of 2 per pedal. BIKEFIT offers a 20mm (0.7874”) pedal extender. So, theoretically, you could take a Speedplay stock Zero Stainless pedal and add 34.4mm (1.3543”) to the pedal stance (per side) by replacing the stock 53mm (2.0866”) axle with a 65mm (2.5591”) which adds 12mm (0.4724”), add 20mm (0.7874”) BIKEFIT pedal extender plus 2.4mm (0.0945”) worth of pedal washers.
  • Cranksets – A simple but more costly option is to purchase a crankset that has a different Q-factor. Depending on the situation, either a wider or narrower Q-factor can help dial in issues with knees and hips.

Natural and Relaxed

If the knees are going out at the top (which occurs in 98% of my clients prior to a bike fit) simply widening the stance in small increments will move the feet outwards so that the knees can travel straight up and straight down.

As stated before, the body always wants to return to its natural, relaxed state. Fitting cleats to a relaxed foot will put the foot in a natural position for pedaling. If the cleats are ill-fit, the cyclist will be subconsciously trying to move the foot back to where it wants to be, which will rob the cyclist of power and more importantly increase the risk of injury. So before looking into any of the adjustments provides, check out your cleat position first. If the knees are going out at the top (which occurs in 98% of my clients prior to a bike fit) simply widening the stance in small increments will move the feet outwards so that the knees can travel straight up and straight down. You may find there is enough adjustment on the cleat to widen the stance without resorting to some of the solutions listed.

Pain shouldn’t be a part of your cycling experience. Muscle soreness and fatigue is normal, but joint pain or numbness is not. As special as your circumstance may be, I guarantee there is a bicycle that can be properly fit to you. Beyond pain or numb limbs, the importance of efficiency and performance is directly linked to how your machine fits your body. It must be said that adjusting any of these parameters will ultimately change other aspects of your fit. An adjustment to one variable can create other issues that you might not realize. Ideally, you’ll get a comprehensive bike fit with a professional who can adjust these dynamic variables in real-time using stationary adjustment systems.

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