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  • jules

    question for Boon (is he reading?) – i have lopsidedness (non-technical term), which was diagnosed by one physio as being caused by different length legs, but then another as due to slight spinal scoliosis. the main symptoms of this are:

    1. unequal pressure on my saddle, which leads to soreness. my gut feeling is that this can be worse than biomechanical inefficiencies.

    2. what i suspect is uneven power output between each leg. i have slightly bigger right leg muscles than left.

    i have been meaning to experiment with fabricating some wedges to correct this. does your report address these issues, or were they more focused on the potential for orthoses to improve biomechanics of riders whose physiologies were otherwise-aligned?

    • dcaspira

      Jules – have a look at G8 adjustable arches. Brilliant product, concept, local as well.

    • Boon Kiak Yeo

      Hi jules, I’m not entirely sure with the full picture of your issue and so I’m afraid I can’t definitively comment on it. However, it sounds like you are seeking biomechanical changes (kinematics) with the use of wedges/orthoses. Based on the current evidence as pointed out in the review, there is no evidence to support the use of it. This does not mean it will not work for your case. As you can see, there is a dearth of cycling research and it points to the fact there is currently no best practice on how and when to use orthoses/wedges during cycling.

    • Ross Hamilton

      Jules if you would like that looked at by a professional you can drop by and see me in practice.
      Let me know if you would like the details.

    • muz

      Bit late to the party but those G8’s really are worth a look. I’ve had them for the last 12 months and should they ever wear out I’ll be buying another pair immediately.

  • SLH

    Who makes the orthotics in the picture?

  • RayG

    This article here says you did a review of the evidence for “foot orthoses, in-shoe wedges and shims”, but the abstract says that the only studies you selected covered foot orthoses and in shoe wedges. The word shim doesn’t appear in the abstract at all.

    I’m curious about shims as I use them to correct a short femur.

    • Boon Kiak Yeo

      Hi RayG, this was just a review on orthoses and in-shoe wedges. Interesting that you picked that up. We also included shims in our search but there were no studies on it and hence omitted it from the review.

  • PsiSquared

    Note that you did not actually carry out a study. You only did a meta-analysis.

    • Tom

      “To address the lack of high quality research in cycling, we are in the midst of publishing a research study looking at the effects of foot orthoses on cycling performance. Along with Dr David Rouffet, an exercise physiologist from Victoria University, we have recruited a population of 24 competitive cyclists and prescribed them with custom-made foot orthoses before assessing their sprint power output using a validated sprint protocol.”

      • PsiSquared

        Yeah, I read that. 24 isn’t a very big sample set. It’s also unlikely–assuming the test is done properly–that they can address the things their meta-study claims to address.

        • Boon Kiak Yeo

          Hi PsiSqaured, the journal article is a systematic review where we collated all current evidence on the topic of the effects of the use of orthoses/wedges during cycling. It was sort of a pre-ample to our research study, which Tom has highlighted above. 24 is not a particularly large sample but it is the biggest sample size out there among all the orthoses/wedges cycling studies – 15 is the next largest.

    • mt

      This may be asking you to “suck eggs”, and is not intended if so.. Scientifically, a meta-analysis is used when available studies have too small a number/sample size to power their study to a statistically significant outcome i.e. there could be a statistically significant difference between orthoses vs no orthoses/insert but the number of participants in said trials weren’t large enough to demonstrate it. A meta-analysis “groups” all these results together to determine if there is any significant difference ( statistically) therefore a meta-analsis can show differences that are significant- they are an analysis, not a study, and are usually a more ” powerful” assessment of trying to answer a question. For my 2 cents medical worth, if an insert better aligns an athletes joints biomechanically and they don’t have ongoing knee/hip and lower back issues due to bio mechanical issues with their feet (on and off the bike), then that’s a good thing.

  • Matt Wikstrom

    I’d like to see the influence on sustained power output when the cyclist is fresh versus a couple of hours later.

  • Dave

    I might just be silly, but wouldn’t it be better to simply get custom shoes that fit YOU properly if off the peg shoes don’t work?

    Orthotics are just a scam perpetuated by podiatrists. If they had to provide a prescription which would be filled elsewhere (like a GP does for drugs or an optometrist does for glasses) instead of selling them directly, the market would collapse.

    • Cameron

      If we don’t all get orthotics, how on earth will we be able to get our Hanseeno shoes made?

  • winky

    I might buy into the idea that foot angle corrections can help with injury prevention; but increasing power output? It doesn’t seem plausible in any but the most extreme cases of leg length discrepancy.

    Indirectly, of course, lower propensity to injury means more/harder training possible with a corresponding increase in power over time.

    • RacingCondor

      This. I have a shim under my right foot to correct a leg length discrepancy but that was always about getting rid of a minor, niggling knee problem that limited my maximum training. At it’s worst my lopsidedness showed in my back muscles (one side much more developed than the other), that is now gone.

      I can’t imagine it makes any measurable difference to power in the short run (unless your shoes are completely wrong for you) but something fixed my knee around the time I shimmed one shoe and I can now train more and reach a much higher level of fitness overall.

      I wouldn’t be surprised if there were other ways to fix my particular problem but I’m happy with what I’ve done.

    • Ross Hamilton

      The idea behind orthoses (yes, thats the plural of orthotic) altering power output is related to altering foot mechanics.
      The idea being that some power is lost during the pedal stroke when mid foot joints shear under load and intrinsic foot muscles work harder to stabilise.
      The University of Cologne published a paper a few years ago showing a small increase in power output during a sprint (where these foot biomechanics issues would be magnified the most). However these results have not been replicated yet despite others trying.

    • lauren o’keefe

      Totally! I have shims because it seems that most road bike shoes these days are designed to deal with pronation, which I don’t have. I couldn’t work out why my lovely, expensive S-Works didn’t feel right – felt like my feet were on an angle – until I had shims put in and they suddenly felt “normal”. But I’d never in a million years say they helped with my power output (hah! what power output?).

  • SteveAck

    Maybe orthotics don’t increase power, but they do benefit performance. Because they prevent you having to get off and massage the hot foot out of your feet! Cobra9 are good – made for cyclists by cyclists. The consultation for instance is totally dedicated to your pedalling mechanics.

  • JBS

    Based on the description of available studies for this area I am reminded of the age old maxim in science:

    “Absence of evidence is not evidence of absence”

    • JBS

      or in layman’s term’s

      “Just because there is bugger all data, doesn’t mean they don’t work.”

      • brucegray

        Agree. Wedges are more often prescribed/used to address overuse concerns, so a study should be conducted long enough to accommodate development of overuse, and recovery from it. However, if someone already has a chronic overuse issue when they start using wedges, and 12mths of wedge wearing doesn’t ease the complaint, it doesn’t mean wedges don’t work. Why? because tissue is compromised prior to wedge use. The crux of the matter is whether overuse would have occurred to the same extent if wedges had been worn before it developed. The authors’ study seems to be asking an overly simplistic question for the multitude of confounding variables around an issue like this – the weather, other life stressors/health issues, diet, hydration, ride intensity/volume, and rate of progression of such. Good luck with the study, but I think there’s very sound clinical rationale for wedge prescription, at least by physiotherapists, podiatrists, and seasoned bike fitters (like Steve Hogg) with a genuine specialty in the field. IME, I see a lot of less educated/experienced individuals recommend varus wedges for overuse issues that have multiple inputs which are not addressed.

  • Sam

    Hi. My left leg is 35mm shorter than my right (actually it’s my femur that is shorter). I went to see Andy Choi at BikePro in Burwood, Melbourne for a bike fit. Andys recommendation was not to use a shim. The end result is that I feel very comfortable on the bike. I don’t feel like I’m over-extending my shorter leg, nor do I feel all cramped up on the other leg (as this is what I experienced after the initial 30min bike-fit from where I purchased my bike). Here are some links to pre & post bike fit.
    Pre bike fit:

    Post bike fit:

  • Steve G

    Cool article.
    I have carbon inserts/orthotics in my SIDI’s. I said on twitter it helped my cadence, connection/fit and power. 160 characters is a bit short to explain.
    The orthotics didn’t give me free rpm’s and watts; they helped my legs track straight whilst pedaling (pedalling? I dunno which spelling is right) and helped with the comfort and fit to the bike as I wasn’t getting hot spots on my feet in certain areas. This allowed me to work on higher cadence and increased wattage.
    Essentially the orthotic helped me do what I was prescribed and let me stay comfortable on the bike longer… they ‘helped’ ME achieve higher cadence and power, but they weren’t ‘free’ rpm’s or watts.
    I’ve recently started commuting to and fro from work on a single speed with shoes that don’t have the orthotics in them. I notice the increased strain in certain areas of the leg after a day or two.

    They work for me, only in the sense in that they help allow me to achieve what’s needed, not that they just give you magical powers by slotting them into your shoes.

  • STS

    A question for you guys at CT: Do you think you do your readers a favor by publishing a metastudy of which even its authors say that the quality of the studies they based their metastudy on was “low to moderate”?
    I have performed some hundred bike fittings and I can reassure you that for a considerable number of cyclists orthodics and wedges – preferably those that sit between outer sole and cleat – make a real difference in terms of comfort and injury prevention (joint alignment). For some, including myself, they make the difference between riding and not riding because of knee and other sorts of pain.

    • Bob Dobbins

      Yes, it is a favor because I can find specific points that address my physical characteristics.

  • Bob Dobbins

    Thanks for the article links. My own two cents worth….i had serious pronation problems as a child. My parents forced me to wear orthotics and fortunately kept at it till I hit a growth spurt and I was largely cured. I am now just a regular mild pronator – which no doubt has greatly improved my quality of life, especially in the fitness arena. So the stuff works on specific problems when properly diagnosed. Second point, a lot of things like wedges have a placebo effect. If you feel stronger, go for it. If it hurts, switch it. As the article points out, there is no silver bullet. Last point, these often involve a trade off between comfort and power. If you aren’t a Pro 1 and are riding something longer than an hour crit, choose comfort and you get the best times.


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