Cycling ergonomics: how to avoid a pain in the foot

Foot pain is surprisingly common among cyclists. Andrew Hamilton looks at the causes 

Although saddle and handlebar comfort are both vital for comfortable cycling, it’s the pedal-foot interface that is the primary site for that all-important energy transfer from you to your bike. Yet while lots of studies have been carried out on cycling injuries of neck, arms, buttock, perineum and knees related to handlebar and saddle design and set up, there’s very little scientific data on foot injuries that occur as a result of cycling and in particular, the pedal-foot interface.

Given that there’s plenty of anecdotal evidence that foot injuries in cyclists are indeed common, Aussie scientists conducted a study to try and identify the typical kinds of foot injuries suffered by cyclists and just how common these are(1). In the study, the researchers set out to answer four questions about foot injuries in cyclists:

1. What is the distribution of age, gender, foot/pedal interface use and distances cycled amongst cyclists who experience foot pain?

2. What type of pain and what region of the foot do cyclists typically experience pain?

3. What techniques do cyclists use to try and cope with/overcome foot pain caused by cycling?

4. Are there key groups of cyclists at greater risk of foot pain than others?

To do this, an electronic survey was used to collect information from cyclists within South Australia, during December 2010. Cyclists were invited to take part and complete the survey if they were riding a non-stationary, upright bicycle at least once per week for a minimum of one continuous hour, and were at least 18 years of age. The sample of cyclists studied numbered 397, drawn from Bike SA (the main representative body for South Australian cyclists) as well as Mega Bike (a large bicycle shop in Adelaide) and staff and students of the School of Health Sciences at the University of South Australia. The cyclists were asked to provide information about their level of cycling participation, the pedal interface used (clipless/toe straps etc) and the types of foot pain suffered.

The key findings

Once all the data was collected and processed, there were a number of key findings that became apparent. The first finding was that over half of the cyclists (53.9%) reported experiencing foot pain whilst cycling. Secondly, it was the forefoot region of the foot that was most likely to be affected by pain (accounting for 61% of foot pain reports), with the participants reporting that the toenails, toes and ball of the foot particular problem areas. The cyclists typically described the pain as ‘burning’ and/or ‘numbness’. The most common methods of dealing with this kind of pain included stopping for a period of time during the ride, shoe removal, walking around and massaging/stretching the foot. In terms of risk, cyclists who rode with an attached foot-pedal interface (ie clipless and toe straps/cage) were 2.6 times more likely to suffer foot pain than those who did not and there was also a correlation with age – cyclist under the age of 26 years were less likely to suffer foot pain than those over 26 (the majority).

What does this mean for cyclists?

Although this was a simple study, it reveals just how common foot pain can be among cyclists. The fact that ‘cleated in’ shoes increased the risk of pain is perhaps no surprise; studies have already shown that these types of shoe tend to localise plantar (base of the foot) pressures, which in turn can be detrimental to nerve and blood supply integrity in that region.

In terms of solutions to foot pain, there is a lack of good research data to support a simple solution. A 2016 meta-study (a study that summarises the findings from previous studies on a topic) looked at interventions at the foot/pedal interface – eg insoles and wedges(2). It found that while these interventions did alter movement patterns of the cyclists’ lower limbs, the lack of standardisation in nearly all of these studies meant that it was difficult to conclude whether there were any actual benefits.

Overall, these results suggest that cycling shoe design and choice could just as important as saddle and handlebar options if you want to remain pain-free on the bike. If you do suffer from foot pain, your cleat design, shoe, insole and the way these are set up could all play a role. Without doubt, the best bet is to consult a physio and/or an experienced bike fitter at an independent bike shop. He/she will be able to assess the likely culprit and make suggestions to ensure you can be pain free again!

References
1. Journal of Science and Cycling 2012; 1(2): 28-34
2. Int J Sports Phys Ther. 2016 Aug; 11(4): 637–650

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