04/24/2014    Jeffrey Root

Wedges Better Than Orthotics in Cycling Shoes: NJ Podiatrist (Robert Scott Steinberg, DPM)

I appreciated Dr. Steinberg’s comments about the
use of orthoses versus wedges in cycling shoes.
Dr. Shier’s comment that cycling is a non-weight-
bearing sport is a little misleading. Cycling is a
partial weight-bearing sport in which the forefoot
is used to apply force to the pedals of the bike
in order to create rotation of the bike’s
sprocket.

As a result of the pressure exerted on the ball of
the foot, the lower extremity, which includes the
subtalar and midtarsal joints, is functioning in a
closed chain environment. It is similar to the
propulsive phase of gait except there is
significantly less force born on the forefoot
because much of body weight is supported by the
bicycle’s seat.

Because the foot is functioning in a closed chain
environment, there is still potential for
excessive motion at the subtalar and or midtarsal
joint. While wedges are single plane devices,
orthoses are triplane devices that act on all
three cardinal body planes, especially the frontal
and sagittal planes. An orthoses does not only
support any forefoot and rearfoot varus or valgus,
it also acts in the sagittal plane to support the
calcaneal inclination angle (lateral longitudinal
arch) and the medial longitudinal arch, which tend
to lower with pronation of the foot. As a result,
an orthoses can provide better support than a
simple wedge.

I agree with Dr. Steinberg that TL-2100 is an
excellent material for cycling orthoses. I
recommend using a short, flat (no motion) rearfoot
post on the orthosis and when necessary, the use
of a varus or valgus sulcus length forefoot
extension added to the top cover. To ensure the
best fit, it is advisable to send the cycling
shoes to your orthotic laboratory along with the
patient’s casts. While wedges may be adequate for
some cyclists, we should not rule out the benefit
of properly made, custom orthoses for treating
symptoms, improving comfort or enhancing
performance in cyclists.

Jeffrey Root, Owner, Root Labs,
jroot@root-lab.com

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