Knee pain in cyclists and their Big Toes

When you've watched cyclists pedalling down the road from a distance, sometimes its quite obvious a knee is tracking in towards the bike. This can be a neuromuscular patterning with excessive adductor magnus or piriformis muscle.

However, a short big toe bone and/or undescended first ray creates a need for the foot to roll inwards to meet the pedal. From here the knee moves in towards the bike.

When an undescended big toe is involved, this medial knee collapse noted in cycling also will also occur in standing/walking. If it is not present in standing/walking its more likely aberrant knee motion is due to the hip musculature.

Where an undescended big toe issue exists, which is fairly simple to assess, a prokinetic orthotic insole may correct it, which a trial in the shoe will clearly show. I can prescribe these types of orthotics.

Sometimes, the big toe can be taught to descend with exercises, but not if its a structural issue. One way to test structural vs functional is to stand on one leg with all your toes straight and "up"off the floor.If the foot still rolls inwards, the toe is likely undescended. Keeping the big toe up, try bending the big toe at its first knuckle without letting the toe drop to the floor.If you can't do this, there may be a muscular component to it.

Correcting a structurally undescended toe (also known as mortons foot) in the absence of other issues, helps sore buttocks and backs, sore knees and hips by removing torsional strains in the lower limbs and pelvis.I people with a slump posture, I have also seen the prokinetic insoles create a more upright posture.

I think it is definitely worthwhile cyclists with anterior hip impingements (eg Osteoarthritis, Iliopsos tendinosis/bursitis, capsular degeneration) to have the foot assessed for this as part of a full screen. Same for medial knee pain.

Matthew Fourro