Different approaches to 1 Problem

Paul got a call form a customer local to me and asked me to go and help him as he was experiencing lateral knee pain on his right side and some pain on and off on his left leg.

Once I arrived at the customer's residence I asked the usual questions, measured his feet for varus/valgus tilt and this is what the FFMD gave me: 0 degrees left and 5 degrees valgus right.
What the customer had placed under his shoes/cleats because he felt that his feet were "sliding off the pedals" were 2 wedges for valgus on the left foot and 3 on the right resulting in the knees to track incorrectly.



This is the orthodic that his orthopaedic doctor made him as a result of being filmed walking however his varus/valgus tilt was never measured. The left orthodic also had some degree of correction for a valgus tilt but not as extreme as the right.

Rear View of Right Orthodic

Side View of Right Orthodic

The issue in this particular case is that the stance was not properly addressed at the time the cleats were mounted. I finished the fit by moving the cleats as far inward as I could in order to get more "support" under the client's feet so he would not experience the "sliding of the pedals" sensation. The best solution in this case is to go for Speedplay Zero's with a longer spindle to get the foot to be properly connected over the pedal. Since this has been his position for 3 years any changes towards a normal foot position may result in the nervous system and muscular system reacting to this as being a weird feeling.

While the philosophy at Bike Fit Systems is to "fill in the gap" and provide support under the foot by use of the cleat wedge or ITS wedge, I have heard of "specialist" in podiatry compensating the other way: so if they had a patient with 10 degrees of varus and orthodic with 10 degrees of valgus would be made in order to have the ball of the foot flat. Coincidentally enough over the week-end I was speaking to Dr Morelli of the Mapei Sport Service Center in Castellanza, VA, Italy about this same issue. He was seeing at their lab many riders "suffering" from knee pain that were fitted with orthodics that were made to change the structure of the foot instead of supporting it.

Of the last 4 fits, 3 of them had 1 foot with considerable amount of valgus! Two of them were almost identical in that they had 8 degrees of valgus on the left foot, 8 degrees of varus on the right and both riders required a Leg Length Shim to compensate for a shorter left leg.

More later ...