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.