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Cycling injuries: are you causing your feet unnecessary pain?

I always recommend cycling to my patients; it's a great cardiovascular workout that's easy on the joints and a fantastic way to get fit, commute or simply have fun. But whether you're waiting for your first bike to be delivered or you've spent the summer taking in the sights of our great city, chances are that you might be making a few mistakes that will cause your feet unnecessary pain and possibly injury.


There's a lot of extremely detailed guides available online for those who know their Shimano STIs from their SRAM DoubleTaps. This isn't for you! This is for the bike beginner who wants to make the most out of their investment, improve their performance and more importantly - reduce their risk of injury.


Below I'll discuss the most common cycling-related injuries I see in our Clinic, and what you can do to avoid them. After all, who better to guide you through foot problems and biomechanics than a podiatrist?



Forefoot numbness or pain

Indiana Jones & The Temple of Doom© Lucasfilm 1984


It's sometimes called 'hot foot'; a compression of nerves and joint tissue by the heads of the metatarsal bones (the met heads) that presents as a pain in the ball of the foot. The clinical name is Metatarsalgia and It's caused by overuse or a sudden increase in strenuous activities.


However, overuse is not the only cause. Being overweight, having a particularly stiff ankle or Achilles tendon can also put increased pressure on the met heads. You might have an especially high arch or you may have something called Morton's Neuroma. which is a thickening of the tissue around one of the nerves. Morton's can feel like you're standing on a pebble or it may be numbness or tingling sensation.


It's important to remember that the term Metatarsalgia covers a wide range of causes rather than just pain caused by overuse, and that burning or numb sensation as you pedal can be caused by a much wider range of biomechanical issues.


If you feel pain in your feet and it persists after a few days, then something is wrong.



Midfoot pain


Most commonly plantar fasciitis: micro-tears to the muscles in the underside of your foot. I see it most often with cyclists using soft-sole trainers or worse, barefoot! Ideally you need rigid-soled cycling shoes (they clip onto the pedal itself).


If you're upgrading to cycling shoes (and I recommend you do) make sure it's a good fit with at least two adjustment straps if they're Velcro. You'll be able to pedal a lot more efficiently and fatigue a lot less quickly.



Blisters & Sore Feet


Do you know your actual shoe size? A surprising number of people don't, assuming the size 9 they've had for years works for every shoe. Fewer still know that one foot is usually a half size bigger than the other. Ideally you should get your shoes fitted by an expert, and later in the day rather than first thing Saturday. If you visit a proper shoe shop you'll quickly see how a practised eye and a little patience can give you far better fit than you're used to.


The IT Crowd © Talkback Thames 2006


If your shoe is a poor fit, the repeated friction and pressure of pedalling will create blisters. Wear moisture-wicking socks and make sure your feet are cleaned, dried between the toes and regularly moisturised. Use thinner socks on hotter days as they'll allow your feet to swell a little, but look out for any swelling or redness as you progress.



Ankle Pain


Again, shoes are the big culprit here: if you're using soft-soled shoes (trainers or worse, slippers!) you'll be putting most of the strain on your forefoot. This also happens when you place your cleats too far forward: in both cases result is ankle pain on the down-stroke and increased inflammation of the Achilles tendon.


Rigid cycling shoes and a more central cleat position (if you're using them) are key here. Cleats in particular can cause all kinds of foot problems if they're too far back or forward, causing you to put excessive strain and wear on one set of joints, tendons and muscles at the expense of others. You may need to experiment a little with the positioning or if you're really serious, consider visiting an experienced bike fitter before you make your first purchase.


The benefits of cycling are amazing, but you should treat it as any serious form of exercise. Warm up before starting your run, use correct footwear and if it hurts - stop. If the pain continues after 24hrs, then I'm only a WhatsApp or web page away!



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