I've covered this topic previously in fairly scientific terms and unfortunately, the jargon contained therein makes for pretty heavy reading. To simplify, let's approach the topic in a more example driven context and explain what we can achieve when using orthotic therapy in cycling. But first, let's run through a couple of the frequently presented pathologies to us at The Pedaler and across our sister brand Cobra9 Cycling Orthotics.
1. Hot foot - Either focal regions or the whole forefoot. Very common.
2. Numb foot - Again, either focal regions or the whole foot. Very common.
3. Painful boney 'lumps' - These can be over bunions or soft tissue swellings.
4. Lower limb overuse injuries - Knee pain, hip pain or ankle impingement. Very common.
5. Arch strain / pain - Typically in the arch or on the outside of the foot. Less common.
The use of cycling orthotics to treat these conditions depends on the circumstances behind their emergence and no broad generalisation of treatment options is possible. However the method by which a cycling orthotic may effect these conditions is set out below.
1. Increasing the surface are for reduction is pressure. Simply, Pressure = Force / Area of distribution.
By providing an increase in the surface area, you can reduce the peak pressure (as long as the force remains constant). We shouldn't over estimate our influence here as the orthotic in the shoe is an inert object. It doesn't 'push' back. However, a stable and well designed shell can alter the pressure.
2. Reducing overuse injuries by altering the direction of force of the pedal stroke. By shifting the angle of the orthotic we can adjust the direction that the load passes through the foot and ankle. Again, we shouldn't over estimate the impact here and imagine meteoric shifts in visual outcomes, but given the repetition involved in cycling, small changes can make a huge difference.
3. Altering focal areas of pressure via prescribed additions. We can modify an orthotic and add a range of options to alter pressure points. Domes, deflection cut outs, dual density materials, memory foam and camber shifts are a few examples whereby you can improve pain by moving load to a tolerable location on the foot.
When treating a cyclist or any patient for that matter, providing generalised treatment prescriptions is impossible. There are far too many other variables to simplify the process down to a pure formula. However, you can begin to see where the relationships emerge.
Someone who complains of focal forefoot burning may benefit from an increase in area of pressure distribution along with selected topical orthotic modifications to shift the load away from boney, swollen or painful regions.
A cyclist with a sore knee due to repetitious knee movement may benefit from altering the direction of load from the 'foot up'.
A cyclist suffering from 'numb foot' may benefit from a reduction in insole thickness paired with changing shoes and/or the alteration of the forefoot load by modifying the shape of the forefoot of an orthotic with a dome / cut out or a combination of both.
As you may have noticed, the concept of power has not been discussed. That is simply because there is no scientific study to back it up and what current studies that do exist within this field are either statistically imperfect or not relevant to the use of prescription orthotics. It is unlikely this will change as placebo double blinded trials with prescription orthotic therapy are incredibly difficult given no two prescribed orthotics are the same and a placebo prescription cycling orthotic is virtually impossible to create. There is however, a great deal of good research into other cycling orthotic based outcomes from a variety of institutions including some very good examples from Brisbane's own University of Queensland.
As a consequence, most studies end with similar conclusions supporting the notion of a case by case approach to orthotic therapy whilst using as much evidence based practise as practically possible. This is our approach at The Pedaler and Cobra9. Our 16 years of experience treating cyclists certainly helps as well.
So when you are considering whether a cycling orthotic is what you need, remember that they aren't magic wands. They are one treatment option among many others and may require fine tuning. Make sure your condition is explained to you first, then the basis behind why orthotic therapy may help your pathology needs to be clearly outlined. Be informed......then get something cool from your Private Health Insurance for a change!!
Nathan White B Hth Sc (Hons) Podiatry, M A Pod A, AAPSM, SMA