Foot Pain and Cycling - Searching for Happy Feet (part I)

 

 

As a cycling activity, cycling has a few immediate paradoxes.  If our body, through eons of adaptation is most ideally suited to walking and, some would argue, running, why is the physical breakdown of people’s lower extremities so commonplace - even inevitable?  Cycling is often seen as a palliative to the degenerative onslaught of the abuse of running and walking.  It’s often used as therapy to facilitate healing with lower body injuries or major surgery. But cycling is an inherently unnatural act.  Put simply, we didn’t evolve to apply forces in our legs in a perfectly round and symmetrical pattern, repeated thousands of times.  Somehow, however, it works.  It is a testament to the body’s ability to adapt to multivariate activities that cyclists can push themselves to repeat this unnatural act long past the duration that would cause us to break down completely when running.  Contemplate for a moment the number of pedal revolutions it would take to complete the Race Across America.  

Still, cycling has a number of characteristics that act to create a pretty common pattern of pain and injury among serious and recreational cyclists.  Identifying the patterns and causes - and solutions - is an ongoing challenge, in part, because the physical loads that cycling applies to the body really haven’t been studied to the degree that other physical activities have.  A persistent puzzle to me as a bike fitter is the recurring issue of foot pain or foot related numbness.  

A cursory search on the internet using some keywords related to foot pain and cycling will typically yield an equally cursory explanation in some bicycling blog magazine and almost prosaic solutions involving loosening the straps to your cycling shoes.  For someone who deals with this recurring and debilitating issue, there’s just not a lot out there.  And for me, there really isn’t a set of bike fitting best practices that address foot pain.  So, as is so often the case, I have to do a little detective work:  ask questions, watch them pedal, look at their shoes, look at their feet, check the amount of varus or valgus of the forefoot, check the level of arch support or ankle pronation while standing, check their current cleat position relative to their metatarsals...and scratch my head a lot.  Often it can be broken down into a systematic and thoughtfully implemented trial and error process to achieve the best results.  But in that process, I’ve made a number of observations.

Another thing about cycling that makes it so different from walking or running is the foot requirements.  Historically, our hunter gatherer nomadic selves would walk up and down and across uneven and rocky terrain.  No pavement back in prehistory.  As such, our foot and ankle is  called upon to do a lot of things when we walk and run.  It moves around a lot. It adjusts to camber angle and general unevenness of the rough ground we walk on.  The arch will stretch and elongate and subsequently rebound with each foot strike - acting as a natural shock absorber.  Our big toe will flex and, working in conjunction with the rest of the foot and lower leg, help propel us forward. 

In cycling, none of that is relevant.  We would prefer that the foot doesn’t move at all.  In fact, all the important things that a foot naturally does, including acting as a shock absorber and moving about to provide stability in an unstable world to our unstable bi-pedal gait (humans are really the only creature that exclusively walks on just two legs, and with our heavy brain and high center of gravity, we have to work a little harder to stay upright) really are a hindrance to effective cycling.  The foot is best when it is stable and stationary, and the lower leg, rather than being a propulsive unit, is better when it contracts isometrically to provide stability for the big muscle groups - the quads and glutes - that are the real prime movers in cycling biomechanics.  Anything other than a stable shoe pedal interface that minimizes what our foot naturally wants to do creates power leakage - an inefficiency in an activity that is, by most measures, extremely efficient. 

So, clipless pedals are meant to provide a stable and efficient connection to the lever that powers the cranks, and shoes, like bikes, have carbon fiber soles that are lighter, stiffer and all the rest.  But applying a static system to a foot and lower limb system creates it’s own issues.  For one, there are pressure hotspots.  We have a lot of foot variability in terms of shape, the thickness of fat pads, the amount of natural arch support we have and the natural movement of our forefoot that we call varus.  I would generally just characterize the set of problems, including pain and hot spots that derive from the static nature of pedals and shoes and cycling in general as Static Foot Problems.  Here are few examples and solutions from some actual fit sessions I’ve had:

Pain on the outside of the foot closer to the mid-foot area.

It wasn’t so much as pain on the sole,  but on that outside edge which corresponded with a wider than normal tuberosity of the fifth metatarsal.  What was the solution?  Well, firstly, this seems like it is a no-brainer, but just getting the right shoes is the first step in maximizing your enjoyment of the sport.  If you have wide feet, don’t get Sidis.  The Giro Empire, as cool and as light as it is, is probably not your best choice.  My default suggestion for those with wider feet for whom this could be a problem are Shimano shoes. A good fitter or retailer should be able to direct you to the appropriate shoe for your foot width.  I wish there was a better system for matching foot width and shape to shoe last.  Alas, maybe I need to invent something.

The second solution was to get this device that looks faintly menacing and almost Medieval and stretch out the upper in just that area that is causing pressure.  This can work, but the device itself works better on traditional leather shoes.  Cycling shoe uppers are designed to resist stretching and hold their shape, so if you try to use it, caveat emptor.

A dull ache and burning sensation that starts under the fifth metatarsal area.

This is where some sort of pressure mapping system for the foot to use during the cycling motion would provide the necessary objective feedback to make effective changes.  Alas, maybe I just need to invent something.  The challenge here to equalize the pressure across a broader, even section of the foot. What’s happening is that there is a hot spot under the fifth metatarsal during the power phase of the pedal stroke, due most likely to a natural forefoot varus.  I’ve had decent luck using wedges to shore up the medial side of the foot and get more pressure over the first metatarsal, but I’m reluctant to rely on wedges for various reasons, and use them sparingly if I can.  The best solution here is a combination of a cycling specific custom insole and possibly and in-the-shoe wedge to prop up that first metatarsal.

 

Fit First, Buy Second - Why Most Consumers Are Getting it Backwards

 

I had a fit session with a client a while back for what I call our Frame Finder fit.  I worked with him for about two and a half hours, set him up on the automated “DFU” fit machine, which is this really impressive motorized fit bike, and made various adjustments based on multiple Retul motion capture scans as well as several questions and feedback until we collaboratively found a position that felt great. I then went through and sorted, based on the ideal fit we settled on, a selection of bikes based on manufacturer, size and stem/spacer combination that matched up with those optimal fit coordinates. It was a deliberate and thorough process that, in the end, yielded an ideal result.  I dutifully built a list of bikes

So fast forward several months.  He comes back in.  He is dismayed.  As it turned out, he bought some ...thing.. off of Craigslist that had some +30 degree stem practically pointed straight up with a frame size that was too small, and, surprise, it didn’t feel right to him.  He wanted to know what I could do.  I offered, in the most diplomatic of ways, that I could try to match the original fit coordinates as best I could or refit him on his bike, which would have involved substantial stem, saddle and handlebar changes, but also involved my time and, subsequently, money.  In the end, he was not a satisfied consumer, and his enjoyment of the sport was compromised.

 

In a way he was lucky.  He only bought some second hand heap and his failed speculative investment wasn’t terribly high.  I submit to you, Exhibit B.  He is a triathlete I subsequently coached who came to me with his very expensive Trek Speed Concept with electronic shifting.  It’s a beautiful bike.  It is a technological tour de force. It does what it’s supposed to do very well.  It was the wrong bike for him.  It placed him in too aggressive a position, which couldn’t be adjusted due to the characteristics of the proprietary aerobar, which subsequently caused shoulder pain and saddle pain and kept him from training and competing in the sport of his choosing.  In contrast, however, to our previous example, this wasn’t his fault.  He went to his local bike shop and the employees there probably gave him the standard eyeball test and asked how tall he was and, if he was lucky, they measured his inseam or something cursory and then selected for him what they thought was the appropriate bike.  Several thousands of dollars later he’s in my studio discovering that it wasn’t the appropriate bike.  For him, based on his needs and individual morphology he needed a less aggressive position and a different bike altogether, which we discovered by pre-fitting him on the DFU with my standard and deliberate process.  

 

High end bicycles, both road and triathlon, are evolving like smartphones at an ever quickening pace; becoming faster, lighter, more comfortable and more enjoyable... and often more expensive.  But the methods consumers continue to use to choose the right bike are still rooted in an era of leather Brooks saddles, steel frames and horizontal top tubes, where sizing the bike involved little more that straddling the top tube, lifting the bike up to your crotch and determining if you have an inch and a half of standover height.  In a data driven era of increased specialization and complexity, absent or faulty data yields poor outcomes.  I submit that we need a different approach.

 

To be fair, bike fit has come a long way from dropping pieces of string from a subject’s knee or the “Italian Slide” technique of placing the heel of the foot on the pedals and checking for leg extension.  The increased specialization, high tech tools (the motion capture system we use being one example) and greater nod to some semblance of scientific rigor is catching up to the enhanced specialization and high tech engineering of modern bikes.  That’s good.  It still think it’s backwards.  Yes, consumers being consumers, we will still make purchases based on emotion.  We have to have that swoopy, sexy-looking Italian bike or that matte black, techie looking triathlon bike with those really tricked out aerobars.  Consumers, however, are also rational enough not to want to waste thousands of dollars on a bike that doesn’t work for them, and are increasingly appreciating the importance of a proper and precise bike fit.  A bike finder pre-fit accomplishes both.  If I work with a client to comprehensively pre-fit them on a capable fit bike with the right evaluative tools, then it’s just a matter of choosing from a list of suitable frames and frame sizes and having it set up to match the coordinates we came up with.  We’ve already determined the proper saddle, saddle height, saddle fore and aft, stem length, stem angle, spacer value, handlebar width, reach and drop and, most importantly, frame stack and reach.  This all might sound like Greek to most consumers, but in this aforementioned era of increased complexity and specialization, the world will need specialists.  That’s where I come in.   The advantage of this pre-fit process is that it very nearly obviates the need for a more comprehensive fit after the fact.  We already know what your proper bike fit coordinates and equipment choices should be.  It’s just a matter setting up your new bike to match, performing a shorter follow up fit and making any additional small adjustments as needed.  So, my advice to you:  don’t be ass backwards with your expensive bike purchase.  Get it done right first and make the right choice.  Enjoy the Tour de France and go Tejay.

 

Bike Fit - Don't Set and Forget

We are now well on our way into the second month of the new year.  Typically, at this point, those New Year’s fitness resolutions have either been discarded to the slag heap of wishful thinking, or you’re actually making some headway, have continued to rack up some miles and are looking to make additional improvements.  Now is a good opportunity to talk about and contemplate some tweaks or changes to your bike fit.

Today is also Abraham Lincoln’s birthday.  Abraham Lincoln is perhaps my favorite human being of all time. He is that rare figure in history who achieved greatness, left the world better and has become a revered figure, not because of the typical traits of aggression, force of will or arrogance, but through wisdom, thoughtfulness and humility. I find that there’s not any question or conundrum that can’t be improved upon by asking, “What would Lincoln do?”  Is there a contemporary social issue or intractable political impasse?  What would Lincoln do?  That person just cut me off on the freeway.  Should I get irate and respond with an obscene gesture?  What would Lincoln do?

So, there’s always a lesson or an example that I can draw upon from history and from Abe’s life that is applicable today. Which brings me to Lincoln’s Lyceum Address.  He was only 28, and at the time, an obscure frontier lawyer trying to make a name for himself and hone his rhetorical skills by giving a lecture to young men in what was then called a Lyceum.  At that time, Lyceums were a common and popular way to spread knowledge and ideas to other adults, a sort of adult education.  The Lyceum movement was Ted Talks, pre-internet. In one particular passage in his address he said of the founding fathers, their legacy and their passing, “What invading foemen could never do, the silent artillery of time has done.”  In his use of his own style of poetry, the use of emphasis and contrast, one sees those distinguishing rhetorical traits he would use some time later in his much more lasting and significant Gettysburg Address.

What does any of this have to do with bike fit?  Honestly, not a lot.  But the example does describe the effect of time, and this is relevant to bike fit.  It describes time, that immutable force of perpetual mutability; in other words, the only constant is change.  As living, breathing bicycle riding entities, we are subject to that silent artillery of time.  We are born, grow, develop, wither and decay in a never-ending entropic process.  In terms of our relationships with our bicycles, our fitness tends to wax and wane the more or less we ride.  Our optimal bike fit when we are just starting out, completely new to cycling, is going to change as we get better.  As we ride more and learn to ride, our whole body becomes more adapted to that machine and that position we spend so much time with.  Our body gets stronger.  The tissue around our sit bones gets tougher.  Our core and postural musculature becomes stronger and more engaged in the task of holding ourselves in an optimal bicycle position. As a result, that saddle can go just a little bit higher.  Those handlebars can drop just a little bit, which might give you more power, better aerodynamics and give you better handling and, ultimately, make you more comfortable.  Conversely, as we age, we shrink, lose flexibility.  Our joints get a little more achy.  The back hurts a little more, and that more aggressive position just doesn’t work quite as well.   As your body changes – and it is always changing – so does your fit.

So, bicycle fit is not Set and Forget.  It does change, and it’s even a good idea to have a fresh set of experienced eyes and some objective data provide a double take of your current position. One thing I’ve realized in a lifetime of seeing different doctors or physical therapists is that diagnoses and opinion vary dramatically.  You also often get different opinions and sometimes different results from different bike fitters – or the same bike fitter.

A good illustration of this are the riders of professional pro-tour level teams.  I was recently at a Retul conference and we were looking at Retul data and case studies from some Garmin Sharp riders.  On many of these pro-level riders, there were some significant changes made to their positions. It struck me that these riders still benefited from having their position on their machines evaluated precisely and having improvements made.  One would think, after years of riding up through the junior, semi-pro and pro ranks, and having any number of various coaches and doctors poke, prod and tweak them countless times, that their positions would be, by this time, pretty well established.  Not so.

The takeaway lesson from this is that there are always improvements to be made to the position on your bike that improve your comfort, efficiency and reduce the chance of long-term injury.  You are constantly adapting, trying to reach homeostasis. You respond to training and additional riding by getting stronger.  Your bike fit should adapt to your individual morphological changes as well.  So, for those who have not yet had their bike fit evaluated, or who have had a bike fit in the past, and if you plan on ramping up your riding and your fitness goals this year, it’s a good idea to have that position precisely evaluated by an experienced set of eyes and the tools to give detailed and objective data.  A good, thorough bicycle fit once a year or so is that buttress against the silent artillery of time.

Happy Lincoln’s Birthday ….B