Common cycling injuries are often due to trying to do, “too much, too soon”, but may also be due to improper equipment, biomechanics, technique, or bike fit. As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.
1. “Hot foot” (numbness and burning in the ball of the foot)
Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling which results in numbness, tingling, or burning, or sharp shooting pains into the toes. Loosening shoe toe straps, wearing wider shoes with a stiffer sole and using anatomical footbed with a metarsal pad will help alleviate the problem.
Besides tight shoes, another risk factor is small pedals, especially if you have large feet. Small pedal surfaces concentrate pressure on the ball of the foot. Switching to larger pedals may be the cure. Re-focus the pressure on the ball of the foot by moving the cleats towards the rear of the shoe. If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.
Physician-designed custom orthotics provide biomechanical benefits and can be made with built-in “neuroma pads”. Cycling orthotics are different than those for runners, as cycling is a forefoot activity, not a heel-strike activity.
Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.
The sesamoids are two small “seed-like” bones found beneath the big toe joint. Injury to these tiny bones can result in inflammation or even fracture, leading to debilitating pain and inactivity. Sesamoiditis can be relieved with proper shoe selection, accommodative padding, and foot orthoses.
1. Achilles tendonitis
Irritation and inflammation of the tendon that attaches to the back of the heel done can be caused by improper pedaling, seat height, lack of a proper warm-up, or overtraining. This condition is usually seen in more experienced riders and can be treated with ice, rest, aspirin, or other anti-inflammatory medications. Chronic pain or any swelling should be professionally evaluated. Floating pedals which allow excessive foot pronation may also worsen this condition.
2. Shin splints
Pain to either side of the leg bone, caused by muscle or tendon inflammation, which may be related to a muscle imbalance between opposing muscle groups in the leg. It is commonly related to excessive foot pronation (collapsing arch). Proper stretching, changing pedals, and corrective orthoses that limit pronation can help.
Some intrinsic knee problems like swelling, clicking, or popping should be immediately evaluated by a sports medicine specialist. Cartilage irritation or deterioration, usually under the knee-cap, can be caused by biomechanical imbalance, improper saddle height, or faulty foot positioning on the pedals. Riding in too high a gear “mashing”, excessive uphill climbing, or standing on the pedals all may aggravate the problem. Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees, feet, and pedals are misaligned.
Pain under the kneecap. Most chondromalacia sufferers can ride at some level no matter how sever the degeneration.
2. Patellar Tendonitis
Strain of the tendon which attaches the kneecap to the leg, this injury often occurs in the novice cyclist or early in the cycling season. The first sign of a problem may be an ominous twinge after cycling in too hard a gear.
Bike fit is key; have a professional check your fit and make bike modifications as needed.
Carefully choose the shoes you will wear in cycling.
Train properly using adequate warm-up and cool-down. If you are doing “too much, too soon” and start having pain, reduce training frequency, intensity, and time.
Pain is not normal and may indicate a medical condition. Seek medical attention from a sports medicine specialist.
Before beginning any exercise program, be sure to check with your physician.
-The American Academy of Podiatric Sports Medicine (AAPSM)
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Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming
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A neuroma is a growth or thickening in the nerve tissue due to compression or irritation of the nerve. While neuromas can develop in different parts of the body, they are most commonly found in the feet between the third and fourth metatarsal toes and called Morton’s Neuroma, or intermetatarsal neuromas. Populations who wear restrictive shoes, or have foot abnormalities such as bunions, hammertoes, flat feet, or more flexible feet, are at a higher risk of developing this type of nerve damage. If you suffer from Morton’s neuroma, you probably already know this by the instant relief from the burning and aching toe pain once you take off your shoes. That’s because the width of your shoes often aggravate an already irritated nerve.
Neuromas have a variety of symptoms that vary from pain to tingling, burning or numbness, and even feeling as if something is inside the ball of the foot. Symptoms often have a gradual onset, first only flaming up when wearing shoes with a tight toe box or while engaging in activities that stress the ball of the foot. Initially, symptoms can be relieved by removing a constricting shoe, massaging the tender area, and by avoiding aggravating activities. However, as time passes, symptoms will get progressively worse. If untreated, neuromas can lead to permanent nerve damage, so consult your podiatrist early about your neuroma.
Treatment and prevention vary. First thing first, make sure you have the proper shoes for your feet! Your podiatrist will first suggest using shoe inserts or special padding techniques to relieve the pressure from the affected area. Additionally, icing, using over the counter or custom made orthotics, modifying activities that aggravate the injury, taking NSAIDs, or even cortisone and local anesthetic injections can help. In more severe cases, surgery will be a viable option to remove the neuroma altogether.
When I am treating a neuroma for a patient I am trying to quiet down an inflamed nerve that is causing pain. The pain can be severe and often warrants fairly aggressive treatment. Other times the simplest form of treatment is all that is needed. Switching to a wider width shoe and avoiding thick socks can often eliminate symptoms from a neuroma. An open toe shoe or sandal works very well for many people with this problem. This is often done in conjunction with a short course of an anti-inflammatory medicine. If this works but not quite enough, the judicious use of a corticosteroid is often tried. I try to limit the numbers of injections given to 2 or 3. Steroid injections can be very effective in reducing the pain caused by a neuroma. Again, we are talking about a condition in some people that hurts so bad they avoid putting shoes on and have eliminated most of their activity due to the pain. Runners will stop running, dancers stop dancing and workers dread going to work. In these cases the possible benefits from an injection far outweigh possible side effects.
Recently, I have had good results with cryotherapy, the freezing of the affected nerve, which desensitizes the area thus reducing symptoms. Finally, their are those neuromas which do not respond to any of the above and hurt enough that excision is performed. The results of excision are favorable. I do the procedure at either Martha Jefferson Outpatient Surgery Center, Martha Jefferson Hospital or Augusta Health. It is a 20 – 30 minute procedure that is done with a local anesthesia and IV sedation provided by an anesthesiologist. Postoperatively rest and elevation is required for 2 weeks. This is followed by 2 weeks of decreased activity and an open toe shoe or sandal. Once successful treatment of the neuroma has taken place patients will get back to normal activity.