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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


What a Week of Racing!

June 24, 2010

Bob McEnaney, a Minneapolis-based cycling coach, contributor to the TRIA Orthopaedic Center blog and Nature Valley Grand Prix fan, has enjoyed another edition of the race. Here are his thoughts on the week that was:

The Nature Valley Grand Prix continued its tradition of delivering top notch racing and exciting action throughout each stage. Both the men’s and women’s races provided excitement to the large and appreciative crowds throughout the 5 days.

Watching each stage as I did (as well as being a rider host), I was impressed and amazed by the effort given by the riders, and their ability to bounce back the next day and do it all over again. We watch the Tour and the other major stage races on TV, but watching them live, up close and personal each day provides an insight that is impossible to pick up on TV, the computer or the magazines.

These riders are forced to ride hard every day, on challenging courses and in all weather conditions. They go back to their hotel or their host housing, recover, sleep and do it all again the next day at a different venue.

As a coach, I’m amazed at the fitness level of these riders. Their actual riding ability, including their bike handling skills is phenomenal. Their ability to generate huge amounts of power – again and again and again – is incredible. And one of the most amazing qualities I see is their ability to recover quickly.

Many cyclists can pull out a huge effort for a one day event. However, this huge energy expenditure can wipe them out for several days or more. So to see – first hand – these riders ability to bounce back is simply astounding.

These are exceptional athletes, there’s no question about this. We’re fortunate to have such a high quality and highly visible race in our own back yard. As cyclists, as athletes and as fans, we need to continue to embrace this race. We don’t know how lucky we are.

Congratulations to the race organizers. It’s difficult to imagine all that goes into putting on a world class event such as this. The number of details, questions, issues and complications they deal with on a daily basis, not only during the race, but the entire year leading up to the race is mind-boggling.

This was a fantastic race, as always. I’m already looking forward to the 2011 edition, and I hope you are as well!


Ask the TRIA Orthopaedic Surgeon

June 11, 2010

Our latest entry deals with a common occurrence on long bike rides: pain in the upper back area. Cycling shouldn’t be a pain in the neck (or a pain in trapezius, either), so when these pains occur, it might be equipment or it might be musculoskeletal. For the answer to this question, we turned to Anne Moore, MD, CAQ, a Primary Care Sports Medicine Physician at the TRIA Orthopaedic Center:

Symptoms of neck and trap issues while biking could be related to both musculoskeletal and equipment factors. If you are riding for a prolonged period of time in a constant position, muscles can become fatigued, sore and tight – sometimes even spasm. This is simply due to inadequate motion of the myotendinous (muscle/tendon) complex. However, if your bike does not fit you correctly, this can also precipitate symptoms. Inappropriate handle bar height, distance, or tilt, as well as incorrect seat positioning, can ultimately result in upper extremity strain/pain. You may want to consider a formal bike fitting to assess for positioning errors. Changing upper body positioning and stretching while you ride will also help reduce neck and upper trap symptoms.


Ask the TRIA Orthopaedic Surgeon

June 4, 2010

Most of the pain in cycling is located on the upper body. Wrists, hands, neck and back are the main culprits for bike-related pain, but the lower extremities are no strangers to pain, either. Knees are a touchy subject, as any slight biomechanical imperfection can cause major pain, as well as the four words that anger cyclists the most: stay off your bike. Michelle Gorman McNerney, M.D., CAQ Sports Medicine is going to address this week’s question: What should I do if the pain while cycling is behind my knees:

While cycling is a great exercise for cardiovascular fitness and large muscle strengthening, there are certain muscles that get neglected when we’re pounding out the hilly terrain. Cyclists, and triathletes for that matter, tend to target their straight ahead muscles, the hamstrings and the quadriceps, with their exercise programs. Many of the stabilizing muscles like the gluteus muscles get neglected with this training. That tends to limit the control you have in the thigh bone when you’re up out of the saddle and the knee cap tends to shift around (like a train off its tracks), causing pain and stiffness.

Pain and stiffness behind the knee can be noted during activities like cycling and running, but the activity can be pain-free with some athletes only noting symptoms after a ride. Interestingly, some of this pain may be detected even with day to day activities and on days where you didn’t even work out or are just sitting at your desk. It is actually common to have pain when sitting for a prolonged period of time with the knee in flexion. It is also common to note this with going up or down stairs.

A cyclist will always want to make sure they are having no swelling in or around the knee. The knee should not be catching or locking into place or feeling unstable (like giving way with walking). If none of those symptoms are occurring, it is safe to try and strengthen some of the stability muscles in the belly, back, and butt to help take some of the stress off your knees when you ride. Some target muscles to think about strengthening are the gluteus maximus and gluteus medius. Also, regularly using the transversus abdominis (not the beach muscles), a core stabilizer of the torso, will contribute to more stable lower extremities. Hip adductors are also a very important and often overlooked muscle group. A few visits with a good (sports) physical therapist is helpful to get on the right track and make sure you are activating the correct muscles and not wasting your time. It may be also worth a visit to your friendly sports physician to make sure there is nothing more significant going on!


Ask the TRIA Orthopaedic Surgeon

May 27, 2010

Cycling is a relatively low-impact sport. When joints ache, identifying the cause is crucial to staying on the bike and out on the road or trail. Ankles can be an issue, especially if there are underlying issues leading to ankle pain.

For the answer, we asked asked Dr. Fernando Pena, M.D., an orthopaedic surgeon with the TRIA Orthopaedic Center, whose specialties include foot and ankle issues, reconstruction, and sports medicine.

The ankle is a very forgiving joint. Ankles are most sensitive to weight bearing activities, and mainly to impact or pounding activities.

Even though some cycling activity may take place standing on the pedals and getting up from the saddle, the forces that cross the ankle joint are not comparable to the forces we put on our ankles when we run across the street (nine times body weight in the case of running).

Ankle pain while riding is likely related to the shoe-toe clip relationship. The two most likely scenarios are from having some intraarticular (inside the joint) pathology (cartilage damage, internal scar tissue and so forth), or from having some sort of malalignment (bowed knees or “X” knees) within the kinetic chain of the lower extremities, and this can include the way your feet are clipped into the pedals, the height of the seat, the tendency to turn in your knees while pedaling in an effort to improve aerodynamics, and so forth.

The only “simple” ankle pain that can be improved is the inside (or medial) ankle pain that is more pronounced when riding hard. That pain likely will come from a tendon struggling to maintain the inside arch of the foot in a proper alignment (the posterior tibial tendon).  Therefore an arch support, either custom made or off the shelf, will have a beneficial impact on inside ankle pain. It is unlikely that pain like this would turn into a catastrophic outcome.  But if left untreated the tendon may become more and more inflamed to the point where riding and even walking are severely painful.


Ask the TRIA Orthopaedic Surgeon

May 20, 2010

Sometimes it’s inevitable: on a longer ride, or on colder days, our hands can begin to feel tingly or numb. In the case of weather, it might be improperly covered digits, but when the numbness occurs on a more frequent basis, it could be something more. Whether it be bike equipment or your cycling gloves, numbness shouldn’t occur in any way, shape or form when you’re riding your bike.

In this edition of “Ask the TRIA Orthopaedic Surgeon,” we got our answer from Deb Bohn, MD, an orthopaedic surgeon specializing in elbow, hand & wrist, pediatric upper extremity, and shoulder fractures. Here’s what she had to say about hand numbness during cycling:

Prolonged gripping, or pressure on the palms, can cause numbness in the fingers. This is due to compression of the median nerve, whose job is to give feeling to the thumb, index, long and half of the ring fingers.  As long as the numbness goes away within a few minutes of letting go of the handlebars, these symptoms are merely an annoyance rather than worrisome.

Some strategies for coping with these symptoms include altering the position of your hands on the handlebars, switching the hand that squeezes the brake, letting your arm hang at your side for a few seconds, using a more relaxed grip on the handlebars, keeping your wrists straight rather than bent way back, or wearing gloves that have pads on the outsides of the palm to keep pressure off the center of the palms.

For more information about Dr. Bohn, as well as the other doctors at TRIA, go to their website and look around:


Ask the TRIA Orthopaedic Surgeon

May 14, 2010

Depending on the stability of our joints, and the ligaments and cartilage enveloping said joints, noises might occur during a variety of exercises. Relatively impact-free, cycling can elicit some clicking or popping in the knee joints when harder efforts (read: gears) are performed, as well as when the knees are fully extended in the pedal stroke when standing up and out of the saddle to climb or bridge a gap. The real question is: should we be worried about that sound or sensation?

For the answer, we asked asked Dr. Fernando Pena, M.D., an orthopaedic surgeon with the TRIA Orthopaedic Center, whose specialties include foot and ankle issues, reconstruction, and sports medicine. Here’s what he thinks about the uncommon sounds and feelings of harder efforts or climbing out of the saddle:

For the most part, clicks, clonks and pops of any joint, as long as they are pain free, should not be a reason for concern. If the noises are associated with some pain or locking, then you should be evaluated by a physician or physical therapist. When it comes to the knee, you could have a torn meniscus (internal cartilage of the joint) that is getting caught or pinched when you bend the knee.  The definitive solution/answer to a problem like this would be to have an arthroscopic (small incisions and looking inside the joint with a little camera and instruments) intervention of the knee.

The only painful noises not to be concerned about are the ones coming from the front of the knee under the kneecap. Cycling, by design, is one of the healthiest sports for the knee cap joint. Appropriate seat height adjustment is critical to help eliminate knee noises and mild discomfort of the front of the knee.