Virtual Case Study: Pain in the Ankle and Foot When Cycling

By following these bike fit, shoe choice, and muscle flexibility tips you can prevent ankle and foot pain when cycling from taking the fun out of your ride.

Patient Presentation: History, Background, and Complaints

Maurice G. limped into my office, barely able to rise up on his toes enough to place one foot in front of the other, and growled, “My dogs are really barking!”  It appeared as if a pack of dogs had their way with his cycling shoes, leaving them void of any arch supporting structure.


Maurice complained of pain in his ankle and foot, especially when climbing hills, as the incline required him to press hard into the pedals or dance out of the saddle.  


In addition, he reported that the clipless pedals he was using allowed for little to no ‘play’ and the pain they caused forced him to ride the only bike available…”one with three shiny wheels.”  

diagram of muscles of leg

Physical Examination

It was painfully obvious upon a visual observation that many miles in the saddle had put considerable stress on the structure of his feet, leaving him with ‘flat or fallen arches.’  


Maurice demonstrated exceptional strength in his legs, but the extreme tightness of his calf muscles made it difficult to bring his toes to his shin (dorsiflex).  


In addition, he had swelling around his heel, which was tender to the touch where the calf muscle attached and upon the undersurface of his foot.

Diagnosis: What is it Called?

Achilles tendinitis

Irritation (Inflammation) of the tendon that attaches the calf muscle (gastrocsoleus) to the heel bone (calcaneus) causes pain and swelling at the heel and makes it difficult to push down on the pedals or rise out of the saddle

diagram of heel pain when cycling
Plantar Fasciitis

Sharp pain felt along the bottom of the foot, greatest at the heel, caused by repetitive irritation (inflammation) of the thick band of tissue connecting the heel bone to the toes meant to provide structure to the arch of the foot.  If left untreated can cause a calcific deposit at the heel known as a heel spur.

Foot Numbness

Compression of the nerves which provide sensation to the top of the foot and big toe causes ‘pins and needles’ and gnawing discomfort.


Repeated stress and excessive pressure upon the ball of the foot while pedaling causes pain focused at the forefoot.  

Etiology: What Causes It?

Ankle, foot, and lower leg pain experienced by cyclists is predominantly the result of improper positioning on the bike and footwear which is problematic.  Read further to learn what bike fit and shoe choices to make when attempting to avoid lower leg pain.

Treatment: What Can You Do About It?

Bike fit suggestions to avoid foot pain when cycling
exercises to avoid foot pain when cycling

Referral: When is it Time to Ask For Help?

avatar riding a big wheel

The Expected Outcome: Conclusion

Lower leg and foot pain is a common complaint of cyclists, especially when long rides during the hotter months cause swelling of the feet, or when varied terrain requires excessive downward force at low cadences or when out of the saddle.


By adjusting your bike fit to decrease excessive strain upon the lower leg, and by wearing cycling shoes that accommodate your feet appropriately, the swollen, numb, and achy feet which once joined you on every ride can become a thing of the past. 

Next appointment

In the next installment in this series, learn what may be causing the discomfort in your upper body while riding and why it is important to address this often overlooked area.

What about you?

Have you found an ankle and foot pain controlling strategy which works for you?  Your fellow virtual cyclists would appreciate the tip.  


Oh yeah…do you know who the famous cyclist Maurice G. is and why he was chosen for this case study?  Take a guess and I will let you know if you are barking up the right tree.

For more great cycling injury treatment and prevention tips check out the Virtual Case Studies page on The ZOM.

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