Many cycling injuries are caused by training errors and equipment problems, but some are due to biomechanics. Two commonly experienced problems in bicycling which are helped by orthotics are forefoot pain and knee pain.

Pain in the forefoot is very common in bicycling because narrow cycling shoes with or without toe straps squeeze the forefoot. This combined with vibration from the road as well as pressure focused on it from pedaling puts excessive stress on all of the tissues in the forefoot. Pain can come from many sources including:

• Hot foot
  
• Metatarsal Bones
  
• Nerve irritation
  
• Skin and Plantar fat pad

Hot foot is condition cyclists frequently encounter. It occurs most often during hard pedaling efforts and is due to focused pressure on the balls of the feet . The focused pressure forces blood from the fat pads on the soles of the feet. Which in turn causes heat to build up which is normally dissipated by the circulation causing a burning pain. It is worse in hot weather because body heat builds up more in these conditions.

Riders with high arches and those who pronate excessively experience it more frequently because they have abnormal increased pressure on the ball of the foot. In addition, wearing shoes that are too tight will aggravate this condition, as will tight toe straps because they restrict circulation. Make sure your shoes are not too tight and keep in mind feet swell during long rides or on hot days, so adjust as needed. Most cycling shoes come with little or no sockliner padding and do not dissipate pressure, vibration, and friction well. If such is the case with your shoes, try adding padded insoles. Moving your cleat position as far aft as possible is also advised. If these remedies prove unsuccessful get custom orthotics. They will balance your foot and redistribute pressure away from the ball of the foot bringing relief.

The same focused pressure and problems with tight shoes that lead to hot foot can also irritate the metatarsal bones, nerves and skin. Cyclists with these problems can also be helped with orthotics. To learn more about these specific conditions follow the links to those topics.

Knee pain in cyclists is very common. It can be from many causes including: training errors, bad technique and poor bike fit, but it can also be from abnormal biomechanics. In regard to training and technique, be sure to use gearing that allows you to keep the resistance low and the cadence at 80-90rpm. Increase the duration and intensity of your rides gradually not more than 10% per week. This will allow your body to adapt to the increasing stress. The cleat adjustment and saddle height are also very important. The seat should be adjusted so you have 145 to 150 degrees of leg extension at the bottom of the pedal stroke. For the cleat adjustment have a bike shop perform a Fit Kit RAD adjustment. This will locate your foot's most natural position on the pedal, so its not being forced in or out. Even with floating cleats this adjustment is important to get the full benefit of the float.

In regard to abnormal biomechanics, knee pain among cyclists is often the result of excessive pronation of the foot. As the illustrations show, abnormal foot pronation results in increased rotation and angling inward of the leg, creating misalignment and strain at the knee.

The abnormal pronation is the result of angular abnormalities between the forefoot and heel, which causes the arch to collapse. The functional orthotic has forefoot posting added to the ball of the foot on the casts to balance the angular abnormality. This is called intrinsic posting and provides even support from the ball of the foot, through the arch and back to the heel. Some have incorrectly tried to address pronation by placing wedges or cants between the shoe and the pedal. This approach doesn't work because canting tilts the entire foot and does not address the forefoot to rearfoot relationship. Do not be misled if you have abnormal pronation and knee pain, get orthotics.

By Dr. Ehrenberg, footdoc@slip.net, who specializes in sports medicine, is on Bicycling Magazines fitness advisory panel and has treated many top bicycle racers.