Tarsal Tunnel and Cycling

I’ve found that sharing posts and client stories are a great way to teach because they are real-life and others can see themselves in the story.  Yesterday I received a question about tarsal tunnel and cycling on the Muscles & Joint Pain forum, and with so many athletes reading my blog I thought that it may help someone else to share the post and my response.  You can read other messages that may relate to you by going to the forum.

Here’s Kyle’s question:

I am an avid cyclist who has done some long-distance touring and sustained some suspected foot/tendon injuries over the past couple of years. I am hoping you might have some insight into what to do to avoid or treat these symptoms.

I first had issues with my left foot on a tour last August. I rode 400 miles through Washington including 20-25 miles of strenuous climbing with a bike that was not geared adequately (pushing too hard to keep momentum up hill). I believe this caused Achilles tendonitis because a couple of days after the climbing I had a persistent sensation (not painful really, just feeling the presence and movement of the tendon in an uncomfortable way) near or at my left Achilles tendon. I stopped riding and rested for several weeks and the issue subsided, but I still felt similar sensations at times after intense cycling.

This May I completed an 1800 mile tour on the east coast. I was worried about my Achilles and was judiciously stretching my calf to hopefully prevent issues, but I did feel something akin to the previous sensation in my Achilles at times when riding, however most all sensation stopped after about a week of riding and I felt fine. About two weeks later, I was riding and abruptly felt a shooting pain on my inner ankle starting near the rear of my left arch and tracing a path up my inner ankle behind the ball of my ankle. This persisted and I stopped riding to rest and stretch for 10-15 minutes, but rode on at an absolute minimum effort pace, taking care not to put weight or strain on my left foot. The pain would also occur when walking every few paces. Later that night though the pain subsided and I continued riding on the tour.

Nearly one week later I felt similar pain and this time rested, stopped to stretch often, and changed the position of my pedal cleats (and therefore the position of my foot relative to the pedals), placing the weight of my foot more forward, on the ball of my foot, whereas previously it was further rear, behind the ball.

The pain again subsided but certain activities, mainly climbing stairs, would trigger mild shooting sensations. I did little riding after this and took a bus to New York, where I spent two days walking (in bad shoes with no support, what an idiot!) and riding some. By the time I left New York I could hardly walk more that 3 paces without feeling a sharp shooting pain.

Upon returning I saw a podiatrist and was diagnosed with tarsal tunnel syndrome. I started using PowerStep insoles, stayed almost completely off my feet for nearly 3 whole days, and took a course of anti-inflammatory medication for two weeks. In a matter of a week I was comfortable walking short distances and riding some as well. It has now been over four weeks since I returned and I can walk and ride comfortably but sometimes when climbing stairs or with other activities I can feel a tinge of the same sensation. I am not confident that I can walk the same distance or ride with the intensity I would like to because of this.

I understand this is a long story but I wanted to provide as much information as possible. Can you recommend any treatment to avoid pain from tarsal tunnel syndrome? Could these issues be related to prior issues with Achilles tendonitis (assuming that is what I experienced)? Is tarsal tunnel syndrome addressed in any of your books?

Thanks so much for your time and patience,

Here’s my response, and I’ll expand it a bit more at the end of this message to make it more clear why the muscles are causing the problem:

After reading your message I believe that everything is coming from the tension in muscles called flexor digitorum longus and flexor hallicus longus. These muscles are directly underneath your AT and they insert into the bottom of your toes. When you are cycling you are obviously straining your calf muscles (gastrocnemius and soleus) and your thigh muscles, but you are also straining the two flexor muscles.

Do you have my book, “Treat Yourself to Pain-Free Living?” If you do, since you are an avid cyclist I suggest you do all of the self-treatments from the hip to the foot. You are straining all of them to a point where they are rotating your pelvis and upsetting the muscles all the way down you leg and into your foot.

Have you read the Home Page on this website? There is a lot of good information about repetitive strain injuries. I suggest you also look at the sections titled “Muscles and Pain” and “What’s Happening Exactly.”

I’ll look forward to hearing back from you after you read the sections.

Oh, one other thing, I suggest you take a look at http://www.TriggerPointYoga.com. This site is about self-treating all of the spasms that are taught in my book, but it adds DVDs on stretches. Ana, the yoga teacher who worked with me to develop this DVD series, is an avid long-distance cyclist so she has a clear understanding of what you are experiencing, she may have some other good ideas for you.

When I decided to write about this subject I took a look online for a good graphic to add so you could see the flexor hallicus longus and flexor digitorum longus. This graphic is excellent, just move the slide down to #10 and you’ll see both the flexor hallicus longus (the muscle that inserts into the bottom of the big toe) and the flexor digitorum longus (which inserts into the bottom of the four toes) is on the inside of the ankle, directly opposite from this muscle. The two muscle tendons pass through the tarsal tunnel so when they are tight they are pulling up on the ligament at the ankle. As the muscles get tight they are pulling the tendons up into the ligament, rubbing it like a knife, so  that will help to explain why they cause tarsal tunnel syndrome.

If you use your thumbs to press deeply into these muscles you’ll feel that they hurt.  Hold the pressure for 30 seconds and then move to the next spot, repeating this until you cover the full length of each muscle. Then, since these muscles curl your toes down, when you stretch it will help if you pull your toes up.

Wishing you well,


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