- September 11, 2021
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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.”
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
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.
Metatarsalgia
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?
- If the pain is the result of a recent injury or is acute (sudden onset within ~24 hours) with swelling, control the symptoms by following the ‘PRICE principle’ (an acronym which stands for Protect, Rest, Ice, Compression, and Elevation) immediately for the next 2 to 3 days.
- Check your bike fit and consider more appropriate footwear choices. Consider being fitted for the shoe insert (insole) or footbed which works best for you.
- Focus upon a high-cadence smooth stroke and avoid pedaling at a low cadence with excessive force on the downstroke. If you use clipless pedals, adjust them to ensure adequate rotational freedom or ‘play’ during the pedal motion.
- Take frequent breaks when your feet start to hurt and choose flatter routes if pedaling out of the saddle causes increased pain.
- Follow a consistent and effective recovery strategy.
- Address muscle imbalances through a focused strengthening and stretching plan, making sure to only perform exercises that can be done pain-free and without residual soreness.
Referral: When is it Time to Ask For Help?
- A proper bike fit performed by a certified professional is always a good idea, especially when the small incremental changes you have made to your setup don’t provide the results or eliminate the pain you are experiencing.
- A progressive periodized training and recovery plan is essential and when followed with the aid of a knowledgeable cycling coach there is a tendency to be more accountable and disciplined.
- If your lower leg pain is persistent, worsens, or significantly interferes with your cycling, seek the assistance of a Sports Medicine Physician, Podiatrist, or Physical Therapist for an expert biomechanical and musculoskeletal assessment and treatment.
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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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!
