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TRIA is a leader in orthopaedic treatment, providing comprehensive care from diagnosis, to treatment, to rehabilitation, even surgery at one convenient location in Bloomington, Minnesota.



TRIA Orthopaedic Center Your Cycling Blog

Ask the TRIA Orthopedic Surgeon: Hot Spots During Cycling

May 27, 2011

As cyclists begin to head outdoors for longer rides, some start to feel pain in their foot, a phenomenon known as “Hot Foot.” Today, Dr. Heather Thoerner, CAQ and Medical Director for the Nature Valley Grand Prix, addresses issues related to foot pain in cyclists.

Hot spots are an uncomfortable challenge that many cyclists encounter as their journeys increase in length and time during the warmer months. With Hot Foot, the rider will begin to feel an uncomfortable burning sensation, often in the ball of the foot. Despite the common thought that this comes from actual heat, ‘Hot foot’ is actually a condition known as ‘metatarsalgia.’ Metatarsals are the long bones of the feet, and ‘algia’ means painful – hence metatars-algia. In cyclists, metatarsalgia occurs when all of the riders body weight is focused on too small an area of the foot overlying the pedal.

Below are the main issues that should be addressed to alleviate or prevent hot foot.

    Bike fit:

proper bike fit and positioning on the bike can be addressed by your local shop or physical therapist. Bike fit has implications for all joints and points of the body.

    Shoe type:

the type of shoe you choose can also help to alleviate hot foot. Start with a stiffer soled cycling shoe with an adequately wide toe box. Carbon fiber, although the most expensive, creates the stiffest platform so that the pressure during a pedal stroke can be distributed throughout the foot, rather just onto the ball of the foot where the pedal sits.

    Pedal type:

a slightly larger platform pedal can also be helpful in distributing the stress.

    Pedal position:

moving the cleat slightly further back on the shoe may help to take the pressure off of the hot spot, but be cautious with these changes as they will change the overall position and alignment of the rider, which may contribute to other joint pain.


shims put between the cleat and the shoe can help to put certain riders into a more anatomic alignment. Again, seek expert advice when altering the foot position.

    Shoe inserts:

the most helpful way to off-load the metatarsals and alleviate Hot Foot is to cushion the area behind the ball of the foot and off-load the pressure point on the metatarsal. This can be accomplished by either a customized shoe insert or by metatarsal padding.


many different brands of semi-custom orthotic inserts can be purchased. These inserts can be bought at many local bicycle shops, outdoor sporting shops, and doctors and physical therapy offices. Again, the goal is to have more support behind the ball of the foot. This will be different from the typical insert that a runner (with heel-strike issues) would want.

    Metatarsal padding or buttons:

over the counter padding can be found at most drug stores. Use the adhesive tape to place the button just behind the ball of the foot.

Whichever method or combination of methods you use to help you alleviate your pain, remember, the goal to alleviate pain is to distribute pressure evenly throughout the foot.

To contact TRIA sports medicine physiciasns, visit


TRIA Doctors Answer Your Cycling Questions

May 14, 2011

Knee pain is a common occurence this time of year. As the miles ramp up with the weather warming up, the tendency is to “over-do” the base mile training. Today, Dr. Anne Moore, CAQ, a sports medicine physician specializing in musculoskeletal primary care, assesses the solutions to cycling knee pain:

Knee pain which occurs with biking is often due to mechanical symptoms, involving both the bike itself and the biker. Proper bike fitting is critical in order to ensure the best alignment and limited load stress at the knee joint. Weakness through the core/pelvifemoral region can result in pain in the patellofemoral joint, tendons about the patella, or iliotibial band. While adequate training is necessary, physical therapy can be helpful to address musculoskeletal/biomechanical deficits. Although knee bracing can be helpful in the short run, physical therapy is more effective at fixing problems on a long term basis.

To contact TRIA sports medicine physicians, visit


The #1 Group Riding Skill

May 4, 2011

The most important skill a rider who participates in group ride must possess is: PREDICTABILITY.

Spring is here and with it the beginning of group rides. Cyclists have been cooped up all winter, riding spin bikes or trainers in basements. These bikes require no bike handling skills and the rider has no need to think about anything other than riding with the planned effort.

We then get outside and ride in a group setting. Riders bike handling skills are reduced from the long winter, fitness is likely not as good, yet the instinct to ride hard in the group is there. Add all these up and the risk of crashes and other incidents is high.

Predictability in the peloton is really nothing more than holding your line as much as possible, then making controlled changes and no abrupt movements. In addition, keep your eye on the road and call out holes and road debris well in advance so both you and the riders around you are prepared to move safely.

Practice riding a straight line on each of your individual training rides. The easiest way to do this is to ride the white line which separates the shoulder from the road. Obviously, this should be practiced on low traffic roads, all the while paying attention to vehicles coming up behind you and moving off to the shoulder smoothly.

If you don’t have access to a road that fits this criteria, simply ride on the shoulder, keeping your eyes well ahead of you and aiming for that area. This should be done while practicing on the white line as well. Focusing your eyes right in front of the bike forces abrupt movements, which is exactly what we’re trying to avoid. Rather, focus 30-50 feet ahead and you’ll remain nice and smooth and on a great line.

There’s nothing more unnerving in a group ride than riding near somebody who’s unpredictable. This person is not welcome in the group and won’t be invited back. Don’t be this person. Practice your riding skills, be smooth and controlled, call out any changes.

Make your ride and the ride of the rest of the group fun and safe. Be predictable.

Feel free to contact me with any questions. In the meantime, GET OUT AND RIDE!

Bob McEnaney trains cyclists, triathletes and other endurance athletes through his company, Total Cycling Performance ( Bob is also the head coach for Life Time Fitness cyclists and other athletes. He has coached and trained endurance athletes of all levels for over 20 years. Bob is certified as a professional Cycling coach through USA Cycling and a Triathlon coach through USA Triathlon. Bob lives in Woodbury and may be reached at