To Your Health: Preventing and treating cycling injuries

This is the second part of a two-part column dealing with proper foot care. Part I appeared in the Aug. 25 paper and is still available at

Every day, podiatrists treat cyclists who have sustained overuse injuries by pushing themselves beyond their limitations. As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.

Among the most common cycling injuries and their causes are:

• Knee pain — Some intrinsic knee problems like swelling, clicking or popping should be immediately evaluated by a sports medicine specialist. Cartilage irritation or deterioration, usually under the kneecap, can be caused by a biomechanical imbalance, improper saddle height or faulty foot positioning on the pedals. Riding in too high a gear, too far uphill or standing on the pedals all may aggravate the problem. Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees feet and pedals are misaligned.

• Shin splints — Pain to either side of the leg bone, caused by leg muscle or tendon inflammation, may be related to a muscle imbalance between opposing muscle groups in the leg. It’s commonly related to excessive foot pronation, collapsing arches. Proper stretching and corrective orthoses for pronation can help prevent shin splints.

• Achilles tendinitis — Irritation and inflammation of the tendon that attaches to the back of the heel bone can be caused by improper pedaling, seat height, lack of a proper warm-up or over-training. This condition is usually seen in more experienced riders and can be treated with ice, rest, aspirin or other anti-inflammatory medications. Chronic pain or any swelling should be professionally evaluated.

• Sesamoiditis — Sometimes known as the “ball bearings of the foot,” the sesamoids are two small bones found beneath the first metatarsal bones; the sesamoids can inflame or rupture under the stress of cycling. Sesamoiditis can be relieved with proper shoe selection and orthoses.

• Numbness — Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling that results in numbness, tingling or burning or sharp shooting pains into the toes. Wider shoes, or loosening toe straps or shoe laces can alleviate the problem. If the problem persists, try a clipless system. Numbness or tingling may represent a serious problem known as “acute compartment syndrome” which requires immediate medical attention.

For those cyclists who desire to match their skills with others, there are four categories of competitive cycling. Category 1 denotes world-class competition with conditions and strategies an average cyclist would not be able to navigate. Category II is also advanced and employs such techniques as drafting, and involves certain “courtesies” of cycling etiquette.

Categories III and IV offer opportunities for fit cyclists to go out and test their mettle against other enthusiasts of the sport. No special equipment is required, only the desire to compete and an adequately trained, biomechanically tuned body. See your local bike shop for schedules of races in your area, As with all competition, start at a low level and work your way up the categories. Remember to put safety first and enjoy yourself.

Dr. Peter Kilfoil is a podiatrist with offices in Southold and Riverhead and he has been a member of the American Academy of Podiatric Sports Medicine since 1984.

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