Orthotics can help re-distribute pressure away from the forefoot or re-align the driving force of the knees’ one way hinge… By Dr. John F. Does PhD, MBA, C Ped (C) In many sporting situations, athletes who would greatly benefit from custom orthotics are limited by the space or ‘clearance’ within the traditional footwear used for the activity. Soccer cleats, track shoes and skates require a snug fit for best performance which creates limitations for the orthotic practitioner. Cycling footwear is no exception. Compared to other athletes, cyclists have unique challenges with foot mechanics. They are not completely weight bearing on the foot, there is no heel strike to toe-off within their repetitious lower limb mechanics and due to the nature of their mid-body position on the bike the entire kinetic chain functions differently during their primary activity. However, the pressure that a cyclist puts on the forefoot may be unmatched in competitive sport. Given that the heel is the biggest and strongest bone in the foot and the metatarsal heads (the ball of the foot) are comparatively fragile, it is no surprise that over-use symptoms in the forefoot are common for cyclists. Redistribution of this pressure becomes challenging when the specialized footwear does not provide clearance for an orthotic device and the long distance cyclist can count on swelling of the feet to occur. And while some conditions require a firm semi-rigid plastic orthotic (thinner), others call for a softer, more accommodating approach within the shoe which unfortunately can take up even more space within these limited confines. The key component to optimizing the interaction with the pedal is understanding how the lower limbs are teaming up to create the forces of propulsion. For instance, if the knee is not relatively neutral in its hinge a simple wedge in the forefoot can make a significant difference. Alternatively, if the ankle is in a compromised position of eversion or inversion, an angled wedge in the rearfoot of an extra stiff shoe may improve comfort and performance. Even with non-athletes who simply require orthotics for walking comfortably, it can be difficult to scientifically optimize the interaction with ground forces. Therefore patient feedback is crucial if practitioners wish to measure success. Due to the unique demands on the body this may be even more important for athletes; especially cyclists. Subsequently, cyclists who seek to optimize their pedal interaction should be prepared for a trial and error approach with a practitioner experienced in such things and who owns an orthotic production facility. Such trial and error may not be well suited to the practitioner who sells orthotics as a sideline; using a contracted lab for production.