Quote:
Originally Posted by Malkor
So this is a call to any Podiatrist who has an opinion on how to realign the seated gait (Taking into account the contact points of the saddle and clipless pedals)! Far too many cyclists damage themselves from poor bike setup and poor pedal/shoe/foot interface and with the need for alternative means of transport... cycling will no doubt have a rise in popularity.
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I don't see many cyclists, but when I do, I make a different orthosis and approach it differently.
In cycling, there is no push off because the first MPJ does not dorsiflex. Additionally, we do not have to worry about equinus as a contributory factor, as the pedal allows for adaptations of dorsiflexion.
Since we are dealing with a modified midstance, we need a midstance orthosis.
Richard Schuster spent a lifetime working on midstance, as he felt this is where the foot is most of the time. The device he made works well for a percentage of people, but the shortcomings are in propulsion, and the sagittal plane theory has made this device sad to say obsolete. I am extremely familiar with this type of device and have found it the best to change posture, and very effective at changing Q angle. Historically, podiatry was moved into public acceptance of our biomechanics by the running boom of the 1970's, and one of the key moments of this was when Richard Schuster treated George Sheehan for chondromalacia patella with orthoses. The results were that the medical editor of Runners World (Sheehan) wrote that if you have knee pain, see a podiatrist first.
The way Schuster made the device was first put the feet in neutral calcaneal stance position by palpation (this was a more supinated position than other notable lecturers that I have seen) and to drop a perpendicular line. This captures the calcaneus to the ground in neutral position. Since the cast captures the forefoot to rearfoot relationship, balancing the negative cast to the line resulted in capturing neutral position. The way he captured the line in the negative cast was to wedge the negative cast before the plaster was poured so that the line on the calcaneus (which transferred to the negative cast) was perpendicular. When the plaster was poured, the top of the positive was parallel to the ground when the cast recreated the neutral position.
In almost all the casts, there was a forefoot varus, and he made devices that had material directly under the first metatarsal head and this material tapered from this point forward.
Again, this device is not a good device for propulsion, as this will result in restrictions of the first MPJ in a large percentage of patients; however, if the patient is in midstance 100% of the time, this is a better choice (as in cycling).
For cycling, I would make a change to the Schuster device. I would make a full length rigid plastic device (polypropylene or graphite), as we do not want the first MPJ to dorsiflex, and this will assist the shoes in doing this. Schuster used leather which can flex for years without breaking down; and a latex wood flour mix, which also allowed for flexion. Since cycling does not have a push off, these materials are not required.
Try it and let me know how it works.
Regards,
Stanley
Foot othoses and cycling
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