From fungal infections to hammertoes and numb feet, cycling can be unkind to your feet in many ways. Sometimes it’s an issue of finding the right shoe, sometimes it’s about hygiene, and sometimes, it’s the result of bad bike fit. We asked Mark Gallagher, a podiatrist with Pure Sport Medicine, to talk about some of the common foot problems in cyclists and how to address them.

Bicycling: What are some of the primary causes of foot pain in cyclists?

Mark Gallagher: First is shoe fit. The cycling industry has worked hard at developing cycling shoes that will deliver power to the bike with innovative materials that are stiff and lightweight. The point where the cleat system is fitted into the outsole has generally improved, although some companies still design a cleat plate that interferes with the internal part of the shoe. That has the potential to create a poor contact point with the undersurface of the foot and increase pressure in that area.

This is a very simple issue that can be avoided when buying shoes. Run your hand into the front part of the shoe and feel for any lumps and bumps that might be a potential area of irritation for you on a long ride. If you feel they are noticeable at this point then you can be sure that they’ll be noticeable out on the bike.

One of the most common complaints I see with my cycling patients is foot numbness while riding. The main driving external force for this is a shoe that is too tight. In the footwear industry, this is referred to as toe box volume and toe box depth, and there are still many cycling shoe companies that are producing shoes that do not reflect the foot dimensions of the general public. Also, the foot volume increases as we exercise – as the blood flow to the muscles increases. The foot will be bound relatively firmly inside the shoe for the duration of your ride so it’s a reasonably oppressive environment. You should also avoid using thick socks to keep the feet warm in the colder months: Layering thinner socks has a better insulating effect and will reduce the volume of the foot in the shoe.

There is a small group of cyclists where symptoms start to affect the foot outside of cycling and this represents a condition referred to as a neuroma. This is essentially a nerve fibre in the foot that has become inflamed and easily irritated. The main symptom: a pins-and-needles sensation in the foot that may affect some of the toes, and may progress into numbness. Treatment options include injections, anti-inflammatories, and footwear or orthotic inputs, and it’s essential to see a clinician with a special interest in foot problems. This person does not necessarily need to be a cyclist but he or she should have a working knowledge of cycling-related injuries.

Will posture affect how your feet feel?

Posture has a lot to do with foot pain. When you’re on the bike there is lot of stress around the low back and pelvis and a reasonable number of cyclists develop foot numbness that is referred from the back as the nerves are compressed at that level. These symptoms tend to respond to time out of the seat, which takes pressure off the back and pelvis. Generally these symptoms will resolve with the periods of time out of the saddle but there are occasions where they persist after the ride. If you have any consistent pain or numbness, then you should have a look at bike fit. A cycling fit specialist will look at your bike setup and also look at what positions you are capable of on the bike.

What can a cyclist do to minimise postural problems?

A bike fit is the obvious first approach, but you also need to consider your flexibility and strength (or lack thereof!) around your lower back. Gym or home-based strength programs can be key to comfort on the bike if performed on a relatively regular basis.

There are some excellent clinicians out there who are skilled in this area. This could be a physical therapist, chiropractor, osteopath, or coach and it’s key to do your homework and ensure that whoever you select has an active interest in cycling. Word-of-mouth recommendations tend to work the best, so speak with your cycling buddies. They may have experienced the same issues.

What are some topical foot problems most common to cyclists?

Cyclists are at risk of soft tissue problems such as athlete’s foot, mainly due to the heat generated while the foot is in an enclosed shoe (and sometimes a shoe cover). This creates an environment for fungal spores to develop, particularly during multi-day events. Riding in wet weather is another risk factor. To avoid this, always dry your shoes after a wet ride and bring more than one pair of socks on multi-day rides and races. And if you develop an infection, treat it early with an anti-fungal cream and continue to use it for seven days straight.

Got any tips for picking out new shoes?

To make sure you buy a shoe that fits, ask about different cleats and pedals at your local bike shop, as they will have great knowledge of the interaction of the foot with the bike. Also, the issue of orthotics (insoles/arch supports) in cycling footwear is an emerging area. Although the mechanics of the foot while cycling do differ from land-based activity, the role of orthotics needs to be judged on a case-by-case basis depending on the problems that the cyclist is experiencing, rather than mass provision of insoles for cyclists just because they are available.

Since feet swell during exercise, does it make sense to try to get out for a ride right before you shoe shop?

In theory, yes, trying a cycling shoe on after some form of exercise would be an option. If the last of the shoe is too narrow and shallow, then simply going up a shoe size might be the answer. Shoes manufactured in Europe can often differ from shoes manufactured in Asia so its worthwhile trying a range of sizes on before buying to see how each suits you.

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