Gear

Technical FAQ: A perplexing foot problem

One reader reaches out to Lennard Zinn for help with a twisted foot that has caused him knee pain

Dear Lennard,
Though my left foot is relatively normal, my right foot points toe-out at a roughly 20-degree angle when my knee is pointing straight. [The first photo above shows] how my foot lands naturally when walking.

[The next photo displays] the position my foot naturally assumes (as in, when using flat pedals) while riding a bike.

If you’ve never heard of this problem, a quick Google search will reveal that, while it’s pretty uncommon, it’s not totally unheard of. I’m telling you about this because I want my battle to find solutions to be available as a path for others to follow.

A note on my personal backstory: I rode at a decent level for a couple years in my early 20s without too much trouble, though I had this problem the whole time. A top rider on club rides, 100+ kms every Saturday, at least another 100km over the course of the week, every week. My foot has been twisted at this angle since birth, but somehow I was able to ride sitting crooked on the saddle and with a much-too-low saddle height, and this accommodated me, though I got knee pain and hamstring injuries every so often that other riders didn’t. I did a lot of yoga and stretching and became extremely injury paranoid over time, which eventually led me to start seriously looking at bike fit — specifically the problem of my feet. I should note that the whole time I was battling this, I was somehow riding at least 150km a week, and just getting injured all the time without fully understanding how far off my bike fit really was. The changes I made I figured out and implemented very gradually as my understanding grew, and feedback from my body became more clear (it sounds weird but I honestly didn’t realize how big of a problem my twisted foot was for a long time, probably because being 15 degrees from ideal feels about the same as being 10 degrees from ideal).

I started out riding Shimano SPD-SL pedals, so I only had 6 degrees of float with the yellow cleats, although of course you can angle the cleat on the shoe — but only so much. The first barrier I came up against was the position of the cleat bolts on my shoes: Specialized shoes have fixed cleat bolts, which only allow for about 9 degrees of twist, even after you include the float from the shoe.

It’s important to note that I tried Speedplay at this point as well, because everyone says that they’re the masters of float and adjustability. But here’s the problem — Speedplay cleats, with or without the adapter plate, CANNOT be rotated. All you have rotationally is the 15 degrees of float on the pedals — but that’s only 7.5 degrees heel-in, and 7.5 degrees heel-out. More than enough for a normal person, but nowhere near enough for me.

The solution to cleat-bolt barrier was to buy shoes with moving cleat bolts. The best on the market right now are Shimano, which allow 11mm of forward-backward cleat movement, with each bolt hole operating independently.

But you may also notice from the above picture when I was at 9 degrees that I was also at the limit of crankarm and chainstay clearance. Any solution to a large amount of toe-out necessarily must include pedal extenders. For myself, I bought Kneesavers from kneesaver.net; this is an indispensable product for dealing with this condition. The website sells 20mm titanium and 25mm, 30mm, or more in steel.

The combination of the Shimano shoes for the cleat bolts and 20mm Kneesavers pedal extenders for the clearance took me to 15 degrees of twist (including the float on the Shimano cleat).

Remember though, I needed 20 degrees. I could get as much clearance as I needed with the Kneesavers, so the problem was getting enough cleat twist out of my shoes. So out came the drill.

But here’s where things get interesting: 3-bolt LOOK style shoes are convex, and 3-bolt LOOK style cleats are concave. They fit together up to a certain amount of rotational twist, but after that the curved triangle shape ceases to be flush. That point just happens to be 15 degrees.

Anyone who needs to go beyond 15 degrees of toe-out rotation will have to get truly innovative. 3-bolt LOOK style pedals go out the window and all that’s left is Speedplay, because they’re flat and will thus sit flush at any angle you need if you’re also using Speedplay-specific shoes with flat carbon soles.

But … they only mount onto these shoes facing straight forward, as noted above.

So here’s what I did: drill a hole in the middle of the carbon shoes, widen two of the existing slots, insert M5 wood T-nuts, and bolt the flat extender base plate (without shims) to the flat carbon sole at the angle that I needed, using the slots intended for connecting to a 3-bolt shoe. Then, bolt the flat Speedplay Zero cleat to the extender base plate, and voila.

Amazingly, I needed much, much more than just the 20mm Kneesaver to get where I needed. In fact, for 20 degrees of rotation, I needed the 65mm Speedplay Zero spindle (12mm longer than normal), screwed into a 25mm Kneesaver, for an astounding +37mm of extension.

BUT IT WORKED. IT GOT MY FOOT WHERE IT NEEDED TO BE, AND MY KNEE WAS HAPPY FOR THE FIRST TIME ON A ROAD BIKE!

Happy ending?

Not yet. After a few rides in my new position, something weird became apparent: I was still sitting twisted. It didn’t take too much searching to find the reason. Because my right foot is so twisted, the heel ends up about 1cm in front of where the left foot’s heel does if both cleats are in the same position.

So my story ends with a question, that only a professional can answer for me. Should I move the LEFT foot’s cleat 1cm back … to move the left heel 1cm forward … so it’s on the same place as the right heel?
— Colin

Dear Colin,
I sent your photos and description to top bike fitters Charles Van Atta of the Boulder Center for Sports Medicine and Katrina (Kit) Vogel, MS, DPT, Director of Clinical Education for BikeFit.com. Here is what they wrote:

Van Atta:

I wonder if he really needed to go for the entire 20-degree rotation. As he switched from the very flexible “flat pedal” shoes to a more supportive road shoe, wedging and arch support might have taken the place of some of his need for external rotation of the foot. If the rotation is the best way to get the knee tracking straight then I think moving the left foot forward would be a sensible approach to even out knee extension at the bottom of the stroke.
— Charles A. Van Atta
Cycling Biomechanist
Boulder Center for Sports Medicine

Vogel:

Moving the left foot forward may be a good option but it depends on the mechanics of both lower extremities and the lumbo-pelvic mechanics. He doesn’t really mention exactly **how** he was seated on the saddle. It sounds like he ended up sitting to the right of saddle midline. His documentation of his case is very detailed, but I need more information to give an informed answer, especially regarding the mechanics of his other leg.

1) Regarding his body position:
a. Knee and shoulder angle? FA?
b. What are the mechanics of right and left lower extremities from the front?
c. Pelvic & lumbar mechanics from the back?

2) Regarding his body architecture:
a. Is the right leg position driven from femoral retroversion and tibial external torsion? Club foot?
b. What is the architecture of the left LE?
c. Has a LLD been ruled out?
d. How much of a forefoot/rearfoot varus is present? If any?

3) What other injuries has he had that may be affecting his position?

4) Which Speedplay pedals did he use?

Answers to these questions will give me the information I need to more fully answer the rider’s question.
— Kit

Dear Lennard,
Thank you so much for taking such an interest in my case. It’s been a real struggle trying to solve this, alone, from Japan.

First an update, unfortunately a sad one. The enormous amount of spindle spacing, which allowed me to have heel clearance and accommodate my twisted leg, has been giving me medial knee pain. Toward the end of rides my knee starts going way out from the top tube — I suspect it’s trying to push down directly onto the pedal, but because of the spacers, this presents a big problem Q-factor-wise. I’ve switched back to +4mm Dura Ace pedals with a 20mm spacer, in search of a compromise between twistedness-accommodation and Q-factor problems.

Now for Katrina Vogel`s questions. Some of my answers are going to be unsatisfactory … I live and work in Japan, currently and for the duration of this battle. Japanese bike fitters and medical professionals have been largely unhelpful; the language barrier contributes to this.

1) Regarding his body position:
a. Knee and shoulder angle? FA?

Within the normal range. 143-degree knee angle last I checked.
b. What are the mechanics of right and left lower extremities from the front?
Unsure what this means …
c. Pelvic & lumbar mechanics from the back?
Probably what would be termed “excessive” anterior pelvic tilt (desk job). I’ve been fighting it for over a year with glute bridges/ab work/psoas stretching, but sitting 40 hours a week = limited success …

2) Regarding his body architecture:
a. Is the right leg position driven from femoral retroversion and tibial external torsion? Club foot?

Tibial external torsion. I’m not so sure what femoral retroversion means, but looking at my leg it’s clear that the twist is at the tibia. Club foot is not present.
b. What is the architecture of the left LE?
Normal is my best guess …
c. Has a LLD been ruled out?
Yes, LLD ruled out by Makito Fushimi of Sun Merit Bike Fit Studios in Japan. He’s affiliated with Bikefit.
d. How much of a forefoot/rearfoot varus is present? If any?
At least some, on both feet. I’ve ridden with various amounts of wedging, and it unquestionably feels better pressure/varus collapse-wise but doesn’t seem to affect where my heel wants to be on the pedal. Currently using three wedges per foot.

3) What other injuries has he had that may be affecting his position?
Nothing other than what I lightly mentioned as the twist being present “from birth.” The longer version is I was born toed-in, and a specialist twisted my feet and casted them toed-out. Turns out this was later disowned by the medical community as unnecessary, as excessive internal rotation of babies’ feet corrects itself spontaneously over time, but nobody knew this in 1986, so now my right tibia has this problem.

4) Which Speedplay pedals did he use?
Zeros

Finally, a question of my own. I don’t have IT band pain currently, but I know my IT band is tight. Is it possible this is contributing to the tibial external torsion? I can’t understand how I was so strong in Canada, riding so twisted, and now it’s such a terrible problem. Perhaps the twistedness increased?
— Colin

Dear Colin,
We unfortunately have not yet been able to solve your problem at this great distance. It is such an interesting case (and a tragic one, given that it probably never would have happened if that doctor had not tried to “fix” your legs when you were a baby), that I thought others could learn a lot from it and could perhaps contribute to the solution.

My experience with myself and many other riders is that the body can handle an astounding amount of asymmetry in bike position when young, but as you age, after having pedaled your legs around millions of times over decades in an asymmetrical position, the body’s adaptation to those repeated stresses becomes an issue in and of itself. There is wear and tear on the articular cartilage in joints that are rotated in ways they were not designed for. Arthritic growth sometimes occurs in response to this high level of wear of the joints. Fascia becomes tight in an effort to reduce the muscle strain required to hold the body parts in positions that the skeleton cannot support alone. Blood flow and ability of the muscles to move are both restricted by the tighter fascia, which can lead to tighter fascia yet to compensate for weakened muscles. The whole process is cyclical, and it leads to ever more restriction. And yes, it’s possible that the tighter IT band, which attaches to the tibia and is a fibrous extension of the fascia of the thigh muscles, could be increasing the external torsion of the tibia.

One can hope that a solution can be found that supports your body in a functionally effective pedaling position that allows your legs to move and be supported properly with minimal wear. In all cases, since we are all asymmetrical, compromises must be made, and that is particularly true in your case. Given that pedaling is a planar movement and your knee and forefoot must go way out of that plane, it may not be a solvable problem. Your forefoot must be so far away from the plane of the bike to not tear up your ankle on the crank that your knee will have to stick way out, and that will cause problems up and down the chain, including up into your back.

One possible piece of equipment that perhaps could ease your problems is the Nikola pedal. The pedal moves outward by 25mm as it goes down, so you might be able to have your knee and foot and ankle further in at the top of the stroke than you do now. By moving outward on the downstroke, the pedal’s movement may allow your ankle to clear the crank as it passes it. But since you don’t need the ankle clearance at the top of the stroke, why not allow your foot to come inward up there? Perhaps that would reduce the medial knee strain.

I’m also hopeful that somebody reading this may offer a piece or two to the puzzle that has the potential to be a solution for you. I can only imagine how hard it must be for you to not be able to find a way to ride your bike without pain.
― Lennard