Cycling and Foot Pain

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Late winter/early spring is prime time for cyclists throughout Houston and southeast Texas. As our mild winters fade away, you’ve probably noticed the annual surge in cyclists on the roadways, whether riding solo or in organized groups. Some of these are casual riders just anxious to get back out there after the cold weather kept them off the bike for weeks or months. Others are getting into serious training for Spring events like the BP MS150 fundraiser or Ironman Texas, or summer races like the ever-popular Memorial Park Criterium series. But as with any other form of exercise, there is always a risk for foot and ankle pain brought on by cycling.

You have several points of contact on a bicycle: the saddle (seat), the handlebars (or aero-bars), and the pedals. Ride long enough and all of them can cause discomfort. It’s not uncommon for riders of all levels to experience blisters on the hands, saddle sores and chafing between the legs, and any number of issues affecting the foot and ankle.

Let’s dive into the most common problems we see among cyclists.

  1. Blisters and rubbing – Blisters occur as a result of repeated rubbing, friction and pressure on the foot. They start with a spot of reddened, sore skin that can develop into fluid-filled sacs as continuous friction is applied. Discomfort can become pain if neglected, and the sac can rupture, leading to an increase risk of infection as well. Blisters are typically caused by wearing ill-fitting shoes. Make sure you wear protective socks and appropriate footwear. If this is an ongoing issue, you can try anti-chafing products such as Body Glide on vulnerable areas to provide a friction barrier as you exercise. We see that cyclists who wear cleats (shoes that clip onto special pedals) tend to have fewer issues with blisters because of the more precise fit and motion control they introduce.
  2. Numbness and tingling – There are a number of potential causes of numbness and that “pins and needles” feeling in the foot among cyclists. Many times, it is due to nerve compression from overly tightened straps or shoes that don’t fit correctly. If shoes are too tight, compression only gets worse with exercise. If too loose, the foot can move excessively, placing pressure on the forefoot or toes. Riders who point their toes downward as they pedal can also crush the foot into the toe box, leading to numbness.
  3. Achilles Tendinitis – The achilles tendon connected the heel bone to the calf muscles. Achilles tendinitis is an inflammation of the tendon, usually as a result of overuse or improper bike setup. Overuse happens when a training volume or intensity are increased so rapidly that the tendons and muscles can’t adapt to the change in workload quickly enough, causing a strain. Bike setup refers to the adjustments made to the bike’s components (primarily handlebar position, seat height, angle and distance) so that a rider can sit comfortably and pedal efficiently without placing undue stress on any part of the body, including the back, hips, knees and feet. If you’re suffering from achilles tendinitis, you should limit activity to allow the tendon to heal, and then start light stretching as the pain decreases and you return to activity.
  4. Plantar fasciitis – Another inflammatory condition, plantar fasciitis affects the band of tissue connecting the heel to the ball of the foot. If you feel a stabbing pain at the bottom of the heel when you get out of bed in the morning, you may be suffering from plantar fasciitis. Cyclists can sometimes ease the problem by fixing bike setup issues, or by improving their pedal stroke technique by engaging in a push-pull using both feet and keeping the feet parallel to the ground at all times (avoid pointing the toes downward).
  5. Hot foot – Hot foot is a condition that produces pain in the ball of the foot. It occurs when you ride a bike for a long period and under high pedal pressure, especially on mountains or hills. Theses changes in elevation cause many riders to mash down on the pedals, sometimes without changing to an optimal gear setting. This excessive pressure can cause compression of the nerves between the heads of each of the foot’s five long metatarsal bones. As the name suggests, there is a burning sensation that makes it feel as if the foot is on fire.
  6. Metatarsalgia and Sesamoiditis – These are two different conditions that cause pain at the ball of the foot, but cyclists can develop either condition from the repetitive stress brought about by pedaling, especially over long distances. Changing cycling footwear or adjusting cleat position can usually address the source of the problem.

How do you reduce the likelihood of foot and ankle pain from cycling?

Cyclists have a challenge that runners and many other athletes don’t: they must rely on and engage effectively with a mechanical device. Below are the top actions you can take to cut down your risk of injury.

  1. Proper Bike Fit – If you bought your bike at a general sporting goods store, you might have chosen something that looked good and “didn’t feel bad.” And, with a few adjustments, you may have even gotten lucky with the general fit. However, if you’ve ever walked into a local bike store (LBS), you probably learned that many bikes come in a variety of sizes for men or women. Furthermore, a salesperson at the LBS will usually have you sit on the bike, and will recommend adjustments that address a lot of the basic “fit” problems mentioned throughout this article – before you roll out the door. This is great for novices who don’t yet know what “feels right.” Regardless of where your bike came from, some of these shops will also offer a “Bike fitting” service. For a fee, they will take measurements of your current setup, and spend time analyzing your position and pedal stroke to arrive at an optimal configuration for the bike based on your goals (training for a challenging event) or problems you’re experiencing (chronic pain somewhere).
  2. Shoes and Cleats – If you’re doing a few miles around the neighborhood park just to enjoy the sunshine and fresh air, the most important thing is wearing comfortable, breathable socks and athletic shoes that fit well. If you’re training for something more, give serious consideration to wearing cleats and clip-in pedals. As far as pedals, there are several different types available, so check those out. These will determine what type of shoes/cleats you can wear. You may also prefer one method of clipping in over another. Try several styles, and don’t be afraid to ask questions as you compare them.
  3. Learn About your Gear – Asking a bike fit specialist why they’re making certain adjustments won’t automatically make you an expert, but you may gain some useful insights if you ever need to make a minor adjustment on your own. This may be something common like raising the saddle a few millimeters, or more specific tweaks, like sliding the cleat hardware back on you cycling shoe to alleviate hot foot symptoms. Being more in tune with the bicycle and gaining this type of knowledge has helped a lot of riders identify and fix issues when something “feels off.”
  4. Maintain Proper Form – As you’ve learned, poor form can lead to foot pain, by placing excessive stress on the feet. As you bend over to ride, a nerve from the spinal canal can be impinged and cause numbness in the foot. Whether you ride casually or aggressively, following good form can help you extend your riding time instead of having to cut it short due to aches and pains. You can also incorporate periodic breaks as you go on long hour rides, or switch between riding seated or “out of the saddle” to stretch and alleviate pressure points.
  5. Keep your Feet Dry – If your socks and shoes are wet due to prolonged periods of riding, you can develop sores on your feet. It may be difficult to keep your feet dry, especially if you are racing, or during long, hot training rides. In that case, carry an extra pair of socks to change into during a break in your ride. In rainy weather, you can also use shoe covers to keep your shoes from getting soaked.
Road Safety
While this article has focused on the overuse injuries that can lead to foot and ankle pain for cyclists, we must also address the importance of safety for ANYONE on the road – including those pedaling, and those behind the wheel of an automobile. The law is clear: we all share the road. Both cyclists AND drivers share responsibility in making sure accidents are avoided. For cyclists, that means observing traffic laws and signaling turns for others in the flow of traffic. For drivers, that means giving cyclists at least 3 feet of clearance when passing, and if possible, an entire lane. There’s no place for road rage or recklessness from anyone. Let’s all respect each other out there!

Have you developed pain or discomfort from cycling or another activity? Call Houston Foot and Ankle Care at (713) 541-3199 to schedule an appointment with Dr. Gabriel Maislos, DPM, FACFAS. Dr. Maislos is a renowned Houston podiatrist who has helped many recreational and competitive athletes recover from foot and ankle pain. For chronic pain, new and innovative treatments may be explored, including Platelet-rich Plasma therapy, stem cell injections and other minimally invasive procedures. We accept most major medical insurance.

Call (713) 541-3199 if you experience:

  • heel pain during or after cycling
  • numbness or “pins and needles”
  • pain in the ball of foot

Houston Foot and Ankle