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January 6, 2013 8:09 PM

Why does biking make my heels hurt?

After a break of a few years I started biking again this year and almost immediately started having heel pain. I also run and do other sports so after the heel pain progressed to "quite bad" I took a couple months off of doing everything except walking. Pain went away- great! Started hiking again and running, no problems. Started biking again and bam two days later my heels hurt. I feel fine while riding but a couple hours later my heels stiffen up and it hurts.

To answer the obvious questions:
-I've done tons of biking in the past with no issues.
-The pain is in the back of my heels and gets worse when I flex my foot and got diagnosed as Achilles tendonitis last summer.
-It also gets worse when I sit or first thing in the morning which sounds like plantar fascitis but the pain is absolutely not on the bottom of my foot at all, it's from the point of my heel up my ankle.
-I'm riding a 29er on tracks and mellow hiking trails and riding slowly, I ever walked the bike up the steep heels.
-I went back to large platform pedals and stiff soled bike shoes so my feet could move around and find a comfortable spot.
-I've gone to a bike shop and had them fit the bike. Two bike shops actually. They both said it looked OK. We've dinked around with pedals and stems and seats. I can comfortably ride for hours at a time on the bike, it only hurts later.
-I have strong ankles and feet, I am a barefoot runner and I also ski and skate and do various other ankle-twisty things with no problems at all. Never had any similar pain.
-It is worse in the morning.
-I've been to the doctor. He told me to rest it.

This is driving me a bit nuts. Other than getting an entirely new bike, which I'm considering, I can't figure out how or why I'm injuring myself in such a specific way after so little biking. Any input from cyclists on similar injuries and how you fixed them or on gear or technique is much appreciated.

posted by fshgrl to health & fitness (22 answers total)

I've had heel pain this past season, but I'm nearly certain that it's my shoes that are wearing out. The padding has worn down, and I've been tightening my straps to compensate. Perhaps one of these might give you something to investigate.
posted by Wild_Eep at 8:27 PM on January 6 [1 favorite]

Wild_ep, I'm on platform pedals and in new shoes so I don't think that's it.

fwiw, the pain is bad enough I limp when I walk.
posted by fshgrl at 8:35 PM on January 6

Clips or traps ?

Also, how are your shoes ? I had a pair of Lakes once that would totally give me soreness in the back of my foot, deep inside, where they kind of rubbed. A half size bigger solved it.
posted by Pogo_Fuzzybutt at 9:00 PM on January 6

Nothing. I'm on platform pedals with no pins and wearing high top MTB style shoes that are comfy enough i could walk all day in them. No clips, no cleats, no toe straps, no power straps.. nothing. Basically sneakers and big ol' plastic pedals. And it's not pain from rubbing, it's interior pain. Presumably my Achilles tendon since that's what i got diagnosed with before but maybe plantar fascitis... ??
posted by fshgrl at 9:10 PM on January 6

Sounds like plantar fasciitis. See a podiatrist. This can be verified by x-rays of the feet, and the treatment can be cortisone shots or custom molded insoles. The shots are fairly painful but they give you 90 days of near perfect relief. The custom molded arches are the permanent solution. I have found that the most rigid of the Superfeet brand insoles (the black ones) work for me, but I believe I just got lucky that those did the trick.
posted by samuelad at 9:20 PM on January 6 [1 favorite]

Have you tried asking over at bikeforums.net ? I don't know of any place on the internet with a higher concentration of people who know about bicycle-related things.

As for my completely non-medically-qualified opinion, the history of Achilles tendonitis plus the morning pain plus the soreness after exercise plus your description of how the pain localizes really suggests Achilles tendonitis. This doctor who told you to rest it, is he aware of your history? Because prescribing rest is entirely consistent with an unstated diagnosis of Achilles tendonitis---that's the first thing to try.

You can try (with your doctor's approval) calf stretches and calf raises. As a fellow cyclist, albeit only a commuter, I do those anyway just because they feel so good.
posted by d. z. wang at 9:22 PM on January 6 [1 favorite]

There's a motion your foot can make with your lower leg that's much more common on a bike than in other activities, I think.

Namely, your toes come up closer to the front of your leg, especially as the pedal is coming to the top of its arc, leaving your foot and lower leg in a configuration similar to what you'd get if you tried to crouch without letting your heels come off the ground, and which stretches the Achilles tendon farther.

You might be able to make this stretch of the Achilles tendon less by using shorter crank arms with your bottom bracket, so that the part of your foot in contact with the pedal wouldn't have to come up as far.

175mm was pretty standard when last I looked years ago, but shorter lengths were available. I'd try 165mm maximum if I were you.
posted by jamjam at 9:25 PM on January 6

Snap e-diagnosis: achilles tendinitis.

Chances are you belong to the 90% of humanity who don't have enough ankle mobility. Give this FMS test a quick try (scroll down for the ankle test video); basically, can you sit in full squat without your heels leaving the ground? Whatever degree of mobility you're lacking in foot dorsiflexion range will go to amplifying the stress on your achilles tendon. Since pedaling is likely the most plantar flexion-loading exercise you regularly engage in, you're feeling it most after doing that.

I'm no cyclist, but the stopgap solution would seem to be to move the pedal surface closer to the heel and/or heighten your seat, both of which should reduce ankle ROM. Improving ankle mobility would be the fix.
posted by Kandarp Von Bontee at 9:50 PM on January 6 [1 favorite]

Is your saddle high enough? I know that you said that you have had the bike professionally fitted, but it really might be your saddle height. If it's too low, you can get achilles tendinitis (as already mentioned), and tight calves/achilles tendons can lead to plantar fasciitis (as already mentioned). Morning heel pain SCREAMS PF to me.

If it's PF, you do NOT necessarily need shoe inserts (though they can be beneficial) or cortisone shots. I got permanent relief from a long-neglected case of PF over 7 years ago with physiotherapy, stretching and home exercises. Massaging out the tightness and adhesions in my soles was crucial, and my blessed PT introduced me to what a little rubber reflex hammer could do (less than $3 at the university bookstore that included supplies for medical students). If you can't get a hammer, you can use a firm plastic eraser instead.
posted by maudlin at 10:22 PM on January 6 [1 favorite]

I get heer spurs, plantar fasciitis and the works whenever my calves or hamstrings get too tight. The tendons that run from your big toe over your arch, over your heel, up your achilles tendon, up your calf, up your hamstring to your hip are all interconnected, and if any of the big muscles gets tight, you'll get irritation at any site along that path, most notably your heel and arch. You might find relief with a stretching routine.
posted by sdis at 10:30 PM on January 6 [1 favorite]

Yes, sounds like your Achilles. The fact that the pain happens afterward and not during makes me wonder if it might actually be a problem of tightened calf muscles, which can pull on the Achilles tendon and put stress on it. Make sure you are stretching your calves very well before and after your rides, and try to increase your distance, ride time, and hills slowly over the course of a few weeks rather than jumping into it.

Also try to make a point of not flexing your ankles too far as you ride - a sensation of almost pointing your toes (you aren't, of course, but that's the motion) to protect from overflexing your ankle.

Worst case - you may have calcification of the tendon and/or bone spurs on the heel bone where the tendon attaches to the heel bone. What kind of doctor did you see? For this kind of persistent problem you need to see a good orthopedist/orthopedic surgeon, preferably one who specializes in ankles and sports medicine. Go in now, as this could indicate a problem that will get worse.
posted by amaire at 10:32 PM on January 6

It sounds to me like your shoes might be flexing too much and aggravating existing sensitivities.

I'd suggest moving to spd clips and a stiffer sole shoe. The fact you can walk in your shoes all day says to me they aren't stiff enough for what you need.
posted by MuffinMan at 12:10 AM on January 7 [1 favorite]

Wow, so many people have not properly read your question. A few things I would suggest trying:

1) Pedal faster but use a much lower gear, at least until the muscles in your legs and feet get stronger. (You use your muscles differently when cycling as opposed to running; strong legs for one doesn't necessarily mean strong legs for the other. I'm a strong cyclist, but just watch me run, it's hilarious!)

2) Make sure your foot is positioned with the ball of the foot, not the arch, on the pedal. A lot of riders pedal with the arch of their feet but this is bad for the knees and ankles and can cause pain long term. Ask a bike shop to take a look at your pedalling technique, not just the size of your bike.

3) Find a physiotherapist who specialises in working with cyclists. The best ones will be able to advise you on the geometry of your bike, your pedalling technique and on any exercises you could do off the bike to ease your pain. You could also discuss any interactions between your barefoot running and cycling - you might be shortening a muscle in one activity when it needs to be longer for the other, for example. Or maybe it's actually running that's doing the damage evn though you're only noticing the pain when you cycle. These are things a physiotherapist can help you figure out.

You could also look into getting clipless pedals and shoes (professionally fitted and adjusted) and see if that improves things at all. There are some nice shoes around these days that have cleats but otherwise look like ordinary shoes, in case you don't like the racer look. One advantage of clipless pedals is that they angle the foot slightly out wards in a way that is difficult to achieve with platform pedals and street shoes, and this better aligns the knees and ankles as you ride. Hope you feel better soon!
posted by embrangled at 12:45 AM on January 7 [3 favorites]

Nthing see a podiatrist (or physiotherapist) who, at the least, specializes in sports, and at the best, knows their stuff about cycling.

I actually wonder if you wouldn't be better off with clipless pedals, and am wondering why the high-top MTB shoes? There shouldn't be anything restraining your ankle movement, I would think? That could actually be contributing to your problems. Although if they were recommended specifically because of your needs, then yeah ignore what I just said.

I started out on clipless pedals five years ago and kind of hated them at first. You need to practice getting out of them while not moving before starting to cycle, and then practice getting out of them while riding slowly, basically build up until you can flick out of them without thinking (or falling over, ha). Once I got used to them, though, holy cow. They really do improve form and enjoyability. I don't get any muscle, foot or ankle injuries from cycling now. And having good (expensive, sigh) cycling shoes makes a massive difference, even to this amateur. You actually should not be able to walk all day in mtb shoes, that says there's too much flex; they should be quite rigid, only comfortable enough to do the occasional portage on foot.

I found that out because I did have an issue a couple of years ago where the ball of my left foot got a strange ache. My GP sent me to a sports podiatrist, who asked to see my shoes, grumbled when he saw the brand (they were moderately-OK mtb shoes, like sneakers), ripped out the innards and told me to look inside: the screws for the pedal attachment had no protection from the balls of my feet, eesh. I was pedalling on screws! He also taught me how to choose mtb shoes for my physical quirks and cycling style. I ended up getting some shoes worth 200 euros that were on sale (end of series) for 120, and they changed my cycling life. Totally worth it. It was like getting a brand new bike, seriously.

Others have given great info about flexibility and stuff (love MeFi, I learned some things here I'll use now), but did want to give an example of how a knowledgeable podiatrist can change your experience immensely! All it took for me was two appointments.
posted by fraula at 1:27 AM on January 7

I would really try a stiffer shoe, and possibly clipless pedals and cleats.

I tend to commute on a bike with platform pedals and just wear whatever shoes I'm wearing to work, and I can tell you the bottoms of my feet *kill* when I wear a soft soled pair of sneakers. Conversely, when I ride my racing bike with clipless pedals and hard soled cycling shoes, my feet are not what hurts.
posted by pixiecrinkle at 7:46 AM on January 7

Thanks all, I will go back to the doctor and the bike store I guess.

For clarity I was using clipless and went to the platform pedals on countless peoples advice to see if it helped. And I'm wearing high tops because its in the 30s here. They're bike specific shoes so I think they're appropriate for riding in.

For future reference for anyone else reading this I feel like a lot of the advice given here kind of ignored where I said I'd only ridden twice to bring on the current bout of pain and is really geared towards overuse injuries. I don't feel that a 5-6 mile slow ride on flat ground is the kind of riding a lot of these answers address. I bike commuted that distance for years on a different bike in all kinds of footwear and had no issues.
posted by fshgrl at 7:52 AM on January 7

If you're getting heel pain hours after a single. small ride on your bike, on two different, widely spaced occasions, then yeah, diagnoses like achilles tendonitis and PF are off base. (I obviously misread the point of pain in your heel part, so that isn't PF: my apologies.)

But please go back and look at your question and comments in this thread, especially the first two paragraphs of your question. You included a lot of useful information, but at no point did you mention that these were just two short, slow rides, versus two periods of time where some cycling of some duration at some speed at some total number of trips happened. While it's clear in your own mind that you took just two rides (and I know how easy it is to think you wrote something that you didn't) and some people here read your question the same way, it was easily interpreted differently by other people reading the same words.

If the pain is happening within a two day period after a single ride (or within a 2 hour period after a second ride), it seems more likely that it is shoe and pedal related. Good luck tracking this down and fixing it!

(Riding in 30F weather: wool socks or gaiters over your pants and shoes might give you more options for staying warm when it's cool just in case your high tops need to be replaced. I ride on platform pedals in sneakers and wool socks when temperatures go down as low as -10C and I am comfortable with that.)
posted by maudlin at 8:33 AM on January 7

Maudlin, I wrote two days. Sorry if that confused everyone, I thought it was pretty clear. Started riding again (in this case to work) and two days later can't walk without a limp. I think there is a major problem with bike geometry but it feels fine and looks ok. Embrangled gave me some excellent suggestions, I'm going to follow up on those.
posted by fshgrl at 8:59 AM on January 7

I think embrangled gives excellent advice.

The one bit I would throw out there is an alternative to look into getting clipless pedals and shoes (professionally fitted and adjusted). Try putting toe clips like these on your bike. It will help properly position your foot on the pedal, but you're not locked into the bike like you are with clipless pedals. (I ride quite a bit, 4000 miles last year, but I still can't do clipless pedals; I want to get my feet off without thinking about it too much.)

Also, a quick bike fit technique is to raise your seat until your heel is on the pedal with your leg fully extended (knee locked). Then pedal with the ball of your foot, which will give you just a very slight bend in your knee on the downstroke (you don't want it quite fully extended while pedaling, but close). I know you've had fits done, but you may benefit from just playing around yourself with the fit. (Can't hurt, right?)
posted by Doohickie at 2:20 PM on January 7

Nothing. I'm on platform pedals with no pins and wearing high top MTB style shoes that are comfy enough i could walk all day in them.

MTB style, as in the shoes with soles designed to provide minimal stability? I would definitely stop wearing those to ride in. MBT users are supposed to be trained to use them correctly in order to avoid pronation symptoms that often result in knee and achilles injury. The shoes are not designed to be used while biking, they are designed to be used in a situation where force is applied and released, i.e. walking. Here's a more technical discussion from Biomechanical analysis of the MBT shoe Functional differences between MBT and conventional shoes during walking:

3. Torque and movement excursion in the lower ankle joint
Use of the MBT results in localisation of the load application point, during the
deceleration phase, farther from the lower ankle joint axis, thus generating higher pronation torque and subjecting the supinators to greater strain. By preactivating the supinators in the prescribed manner, the subjects were able to increase supination prior to making contact with the floor, thus ensuring that the pronation position returned to normal following the deceleration phase. This in turn can occasion either supinator training or supinator overloading. Further studies are needed in order to determine which of these effects occurs over the long term. However, one thing is certain: If MBT users are not taught exactly how to use the shoes, these users will inevitably experience massively elevated pronation, which will in all likelihood provokeclassic pronation symptoms in the knees, Achilles tendon and elsewhere.
posted by oneirodynia at 3:09 PM on January 7

I've had the exact situation as you (down to the 29er). I was running and biking every other day for about 2 weeks and the back of the heel pain started. I thought it was the running, but it turned out to the be the riding. I had the same situation as you where I rested and everything felt great and then biked again and it kicked in. I played around with my bike seat configuration and determined that it was that my seat was too high and I was extending my toe too much. I also suspect that the new shoes hadn't been broken in properly and the extension and the unbroken, hard back of the new riding shoes was irritating my tendon. I broke in the back of the shoe manually until it was softer and I lowered the seat a bit and I've been riding my 20mi rides with no problems last summer.
posted by kookywon at 5:12 PM on January 7 [1 favorite]

MTB style

As in MounTain Bike style.

I evidently didn't make it clear as half the answers here tell me to buy bike shoes but I am wearing totally acceptable and commonly used bike shoes. In my size.

Doohickie, I had those once and I would totes get them again for commuting but my experience riding off road is that they can break and then you have a sharp thing on your pedal pointing at your foot. Not everyone is as graceful as me, of course.
posted by fshgrl at 8:50 PM on January 7