Nov 22

Written by: Larry Huppin, DPM
11/22/2010 1:12 PM

I have a number of patients who develop numbness, tingling and other neuritic symptoms while bicycling. We have been very successful treating these problems with a combination of foot orthoses and shoe changes.

My assumption is that the neuritic symptoms occur for two reasons:
1. Pressure from the axel of the pedal directly under the metatarsal heads leading to inflammation and compression of digital plantar nerves
2. Shoes that are too narrow due to swelling of the feet during longer rides

Our orthosis treatment is focused on reducing pressure under the metatarsal heads. Bicycle shoes, however, do tend to run small relative to running shoes and some orthotic modifications specific for bike shoes are often necessary. Our recommended bicycle shoe orthosis is as follows:

• Direct milled polypropylene. 2mm thick for under 150 pounds and 3mm thick for over 150 pounds
• No rearfoot post
• Spot grind on heel
• Shallow heel cup
• Standard width (or fit to shoe if you can send in the bike shoe)
• EVA soft cover to toes. Sulcus length to avoid taking up room in the toebox. Glue cover posterior only.
• Poron forefoot extension to sulcus

When discussing bicycle shoes, make sure your biking patient understands that their feet may swell considerably on a long ride and it is critical to avoid forefoot compression if they are going to avoid neuritic symptoms. I recommend that patients purchase their shoes either at the end of a long ride or to wear an extra pair of socks when trying on the shoes. When they ride they can wear the extra pair for the first part of the ride and then take off the extra pair later in the ride.

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