For me, cycling is one of the best activities in the world. And I think my sentiment resonates with the growing number of cycling aficionados out there in Singapore. This huge increase has led to an increased thirst for knowledge concerning evidence-based treatment in preventing and treating cycling injuries.
As a cyclist myself, the sport is still enjoyable even as my legs burn with lactic acid, and I can creak slowly home. This part might sound like a Hair Club for Men TV commercial where the president of the company is “also a client!” (you have to be at least 30 years old to remember; or, for the young whippersnappers, YouTube is where it’s at).
But I do love the custom cycling orthoses made specifically for cycling shoes that The Foot Practice has been manufacturing for the past several years. And as a passionate cyclist, I wanted to learn more about how they really work.
Part of every treatment is a good clear explanation of what is happening and how it can hasten healing or prevent an injury. I make it a point to read a plethora of quality, evidenced-based research in order to better understand health treatment options to ensure the advice I give is not just based on my own anecdotal evidence.
Singaporean podiatrist and former professional racing cyclist, Yeo Boon Kiak, wrote research papers on cycling inserts utilizing the qualitative research method interviewing high-level cyclists and bike shop owners. I was eager to find other articles to support the notion that cycling orthoses increased comfort, improved concentration, and enhanced power, speed, durability, and all-around fantastic improvements.
I always need to factcheck everything. I want to know that all those promises I’ve declared about the product are based upon research. I ignore the logical assumptions and fallacies that seem so believable and, instead, shift to absolute data. But the data was missing. To my dismay, there’s no clear overarching evidence that supports or detracts from the notion of improved comfort, power, speed or durability with cycling inserts.
Since starting clinical practice, one thing I have heard from patients is “of course, that’s logical” after explaining something. But after more than two decades in practice, I have come to discover that what we understand today regarding body movements was was considered a farce years back. This shifts how we treat conditions and treatment plans. What is logical today was considered misguided before. The trouble with logic is not that it is different from common sense. It is more often than not based on the most convincing explanation.
By discussing with some brilliant surgeons and physiotherapists, healthcare providers do their best to gather as much evidence-based research to support a theory – a “cherry-picked” story of sorts – to back our arguments and/or assumptions to provide the best care for patients. As healthcare providers, we need to check our emotions at the door and resolve to base our treatment plans on facts.
So what do custom-made cycling soles actually do?
From my initial research, I have found that custom-made carbon soles stiffen a shoe, which improves the lever arm and increases push-off. Several of the bike outfitters with whom I spoke with sell general soles. They found the custom soles took up too much space inside the shoe, especially considering heat and foot swelling on a 4-hour saddle ride.
Despite my emotional attachment, I was unable to find a large body of research that supports the connection between custom-made cycling soles and an increase in performance or power. However, I realized through my research, that I am not alone in trying to find hard data that proves the positive effects of custom-made soles. Other enthusiasts and physiotherapists have been trying to prove the apparent logic underlying the custom-made cycling soles, such as Yeo Boon Kiak and Daniel R Bonanno. Bonnano and Yeo compiled a paper, assessing studies concerning foot orthoses and improved performance (Source). They found that other researchers have tried to find empirical proof that custom-made soles improve or worsen performance by measuring oxygen consumption or examining kinematics, but were unable to find conclusive consensus.
But performance is not the only thing that matters when cycling. Bonnano and Yeo cite a study by Jaquelin A Bousie, Peter Blanch, Thomas G McPoil, and Bill Vicenzino from the School of Physiotherapy, University of Melbourne, that found foot orthoses increases the contact area under the foot, reducing peak forces, meaning the maximum force of torque developed during a muscle action (Source). When read with other scientific studies on peak forces, we see that custom-made soles, in reducing peak forces, can reduce heat spots, therefore potentially alleviating foot swelling on long cycles. The term “hot foot” or Metatarsalgia refers to a condition when the balls of your feet become painful and inflamed with periods of increased pedal pressure where the nerves are repeatedly aggravated by the metatarsal bones resulting in a burning or numbing sensation of the foot due to the compression.
So in summary, although the research is limited in defining whether cycling orthotics increase your performance or power they can reduce peak pressures and possibly reduce injury risk, which is nothing to scoff at! Cycling orthotics can work as a rehabilitation device whereby injuries can be offloaded by the reduction in peak forces. Custom-made orthoses, furthermore, produce higher plantar pressures which are more spread across the foot than standard pressures, when used in combination with good bike fitting and comfortable shoes, reducing the risk of overuse injury. This may have real implications for their use in the prevention and/or management of overuse injuries in the knee and foot.