Orthotics and in-shoe wedges have been recommended and used by cyclists for a number of reasons including increasing power, increasing comfort, injury management, and injury prevention. The mechanism of how orthoses theoretically work in all these situations is to improve lower limb alignment and efficiency of movement. But is that really the case? And what evidence is there to support these claims? A recent study published in the Journal of Foot and Ankle Research gives us some further insight into whether orthotic insoles are beneficial for cyclists.
Researchers from La Trobe University in Melbourne Australia performed a systematic review of all the available literature on the topic and published their analysis in 2014 (1). The review identified 362 potential papers, however only 6 studies were included in the review after screening and assessment of quality. Five of the studies used orthotics and one study investigated in-show wedges with a variety of outcomes being assessed. These outcomes included hip and lower limb biomechanics, cycling performance, oxygen consumption, and power production.
The study that looked into lower limb biomechanics found no significant differences between those who had orthoses and those who didn’t. Although this study made it into the review, the number of subjects was small (12 cyclists) and the methodological quality rating was low, so the results should be viewed with caution. The authors of this study reported that subject-specific biomechanical effects were noted and that an individualized approach should be taken. I agree with the recommendation, particularly for cyclists with knee and hip issues, until there is further research and evidence to say otherwise.
Two of the studies that looked at physiological effects, particularly oxygen consumption, had conflicting findings. The findings of these studies too should be interpreted with some care as the majority of subjects assessed were wearing flexible running shoes and flat pedals. Obviously most cyclists who are looking to improve oxygen consumption on the bike will be in cleats, which allow better transfer of energy from the shoe to pedal and have different (enhanced) plantar pressures. Unfortunately these studies lack quality and application.
Two studies investigated the effect of orthoses on power production. One of these studies assessed forefoot varus wedges and noted no difference or improvement. It must be mentioned that this study analyzed untrained males, so this study too cannot be generalized to trained cyclists. The second study did however use trained competitive cyclists as subjects and investigated the effect of cycling specific carbon-fibre foot orthoses versus a sham device. There was no difference in power output between groups in this study.
The final study in the review reported that orthoses provide increased conformity to the foot by increasing contact area under the midfoot/arch. However this increase conformity did not translate into an increase in comfort on the bike with no differences between the orthoses and control group.
In summary, there is only limited research into the effect of insoles, orthotics and in-shoe wedges in cycling. The available evidence however suggests that there are no benefits in power output or oxygen consumption. No definitive conclusions can be made on the effect of orthoses on cycling biomechanics with further research being required in this area.
My recommendation is to take an individualized approach for the management of an injury or correction of poor cycling kinematics, however don’t go and buy a pair of orthoses thinking that they’ll improve your comfort or speed.
Yeo and Bonanno: The effect of foot orthoses and in-shoe wedges during cycling: a systematic review. Journal of Foot and Ankle Research 2014 7:31.
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