Introduction
Review
Search strategy
Keywords used | (orthotic OR orthoses OR orthosis OR inner-sole OR insole OR wedges OR shims) AND (cycling or bicycling or cyclist or cycle) NOT (gait cycle) |
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Inclusion criteria | 1) All empirical studies that evaluated the effects of foot orthoses, insoles, shoe inserts and in-shoe wedges on cycling. |
2) Outcome measures included kinematics and kinetics of the lower limb, physiological parameters and performance. | |
3) Published in English language. | |
Exclusion criteria | 1) Studies that examined pedal modifications only. |
2) Studies that examined orthoses or wedges external to the shoe. | |
3) Studies that had subjects with significant or chronic disabilities or diseases that may affect the ability to cycle. | |
4) Unpublished data. |
Methodological quality assessment
1. Clear aim/ hypothesis | 2. Outcome measures clearly described | 3. Charateristics of patients included clearly described | 4. Interventions of interest clearly described | 6. Main findings clearly described | 7. Measures of random variability provided | 10. Actual probability values reported | 11. Subjects asked to participate representative of population | 12. Subjects prepared to participate representative of population | 14. Blinding of subjects | 15. Blinding of outcome assessor | 16. Analyses performed were planned; no data dredging | 18. Appropriate statistical tests used | 20. Valid and reliable outcome measures | Total (score out of 14) | |
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Anderson & Sockler, 1990.[19] | 1 | 1 | 1 | 1 | 1 | 1 | 0 | U | U | 0 | 0 | 0 | 1 | 1 | 8 |
Bousie et al., 2013.[17] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | U | U | 0 | 0 | 1 | 1 | 1 | 10 |
Dinsdale & Williams, 2010.[4] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | U | U | 0 | 0 | U | 1 | U |
7
|
Hice et al., 1985.[18] | 1 | 1 | 0 | 1 | 1 | 1 | 0 | U | U | 0 | 0 | 1 | 1 | 1 | 8 |
Koch et al., 2013.[7] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | U | U | 1 | 0 | 1 | 1 | U | 10 |
O’Neill et al., 2011.[20] | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | U | 0 | 0 | 0 | 1 | 1 |
7
|
Statistical analysis
Results
Quality assessment of included studies
The effects of foot orthoses during cycling
Author | Participants | Shoe, cleat and pedal characteristics | Intervention | Measures collected | Study design | Outcomes |
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Anderson & Sockler, 1990. [19] | Ten healthy adult subjects (six males, four females). | Three males and three females wore stiff-soled cycling shoes with cleats. Four remaining subjects wore flexible-soled running shoes without cleats. | Participants were tested with custom-made foot orthoses (CFO) or without any orthoses. The CFOs were made from Rohadur®. Orthoses were molded using a non-weightbearing, netural position casting technique and included a rearfoot 4° inverted post and an intrinsic forefoot post with 4° motion. | Oxygen consumption, expired ventilatory volume, and heart rate. | Randomised, repeated measures, non-controlled study. | There were no significant differences in oxygen consumption, expired ventilatory volume, or heart rate between both conditions (p > 0.05). |
Mean age: 29.1 years (±2.1) | ||||||
Mean height: 176.0 cm (±3.1) | ||||||
Mean mass: 65.5 kg (±3.2) | ||||||
Bousie et al., 2013. [17] | Twelve competitive or recreational cyclists (eight males or four females). | Each participant wore their personal cycling specfic cleated road cycling shoes with a rigid sole, and used their personal pedals. | Participants used commercially available contoured orthoses and a flat non-contoured insert (Vasyli International Australia). Both orthoses and flat inserts were made of ethylene vinyl acetate (EVA), with the same hardness. | Plantar contact area, peak pressure, perceived comfort, and support of foot plantar surface. | Randomised, repeated measures, control study. | Compared to flat non-contoured inserts, the use of contoured orthoses led to a statistically significant increase in the contact area of the medial midfoot (p = 0.001; MD 5.7, 95% CI 3.0 to 8.4; SMD = 1.3) and lateral midfoot (p = 0.009; MD 4.6, 95% CI 1.4 to 7.8; SMD = 0.9). Contoured orthoses also produced a statistically significant increase in plantar pressures under the hallux (p = 0.003; MD 21.4, 95% CI 9.1 to 33.6; SMD = 1.1). Compared to the flat insert, the contoured orthoses was perceived to better support the arch (p < 0.001; MD 3.2, 95% CI 1.8 to 4.6; SMD = 1.5) and heel region (p = 0.013; MD 1.3, 95% CI 0.3 to 2.3; SMD = 0.9) but no difference was reported for perceived comfort. |
Mean age: 35.1 years (±10.6) | ||||||
Mean height: 174.7 cm (±8.7) | ||||||
Mean mass: 70.0 kg (±9.8) | ||||||
Weekly riding distance: 285.4 km (±82.9) | ||||||
Hice et al., 1985. [18] | Five healthy adult cyclists (three males, two females) who cycle at least 3 hrs weekly. | All participants wore flexible soled shoes and used flat pedals. | Participants were tested with custom-made foot orthoses or without any orthoses. The CFO was made from rigid thermoplastic and were ¾ length. A neutral suspension casting technique was used to make the orthoses. Forefoot posting was applied to each CFO to achieve forefoot-rearfoot alignment. | Oxygen consumption and heart rate. | Non-randomised, repeated measures, non-controlled study. | A statistically significant decrease in oxygen consumption was found during the orthoses intervention when compared to no orthoses (p < 0.05). A decrease in heart rate was also observed when the subjects wore the orthoses compared to not wearing them, although only measurements at rest were statistically significant (p < 0.05). |
Koch et al., 2013. [7] | Eighteen competitive male cyclists and triathletes. | There was no report of shoe, cleat and pedal characteristics that each participant used. | Participants were tested with cycling specific, commercially available, carbon-fibre cycling orthoses (Solestar, GmbH, Berlin) or non-contoured inserts. | Mean power production, peak power production. | Randomised, repeated measures, single blinded, controlled study. | There were no significant differences mean power production (p = 0.76) and peak power production (p = 0.53) between both conditions. |
Mean age: 26.3 years (±5.6) | ||||||
Mean height: 181.9 cm (±4.7) | ||||||
Mean mass: 76.7 kg (±4.4) | ||||||
Foot length: 28.2 cm (±0.8) | ||||||
O’Neill et al., 2011. [20] | Twelve competitive cyclists (nine males and three females) | There was no report of shoe, cleat and pedal characteristics that each participant used. | Participants were tested with their own cycling-specific custom-made foot orthoses or without any orthoses. A variety of materials were used for each participant’s CFO, such as carbon fiber, polyvinyl alcohol (PVA) and plastic material. 10 of these orthoses were full length, while the remaining 2 were ¾ length. There were also a variety of modifications added to each orthoses, such as rearfoot and forefoot wedges, 1st metatarsophalangeal (MTPJ) cut out, metatarsal domes. | Maximum hip adduction, maximum knee abduction angle, total range of motion of tibial rotation, and coronal plane knee movement during the power phase of pedal stroke. | Non-randomised, repeated measures, non-controlled study. | No systemic effects from the CFOs were seen. Statistically significant subject specific effects, such as reduced tibial internal rotation motion, increased knee-to-bike distance and reduced knee abduction angle, from the CFO were reported (p < 0.05). All subjects had significant left to right leg differences during the power phase of pedalling. |
Males | ||||||
Mean age: 40.0 years (±14.8) | ||||||
Mean height: 179.4 cm (±7.6) | ||||||
Mean mass: 82.7 kg (±8.0) | ||||||
Cycling experience: 14.0 years (±9.7) | ||||||
Females | ||||||
Mean age: 29.0 years (±4.0) | ||||||
Mean height: 169.7 cm (±7.3) | ||||||
Mean mass: 63.6 kg (±7.5) | ||||||
Cycling experience: 8.3 years (±3.1) |
The effects of in-shoe wedges during cycling
Author | Participants | Shoe, cleat and pedal characteristics | Intervention | Measures collected | Study design | Outcomes |
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Dinsdale & Williams, 2010. [4] | Six untrained males with a forefoot varus. | There was no report of shoe, cleat and pedal characteristics that each participant used. | Participants were tested with and without a forefoot varus wedge from commercial company, Specialized Bicycle Components. The size of the varus wedge (ranged between 1–4 degree) was customised to the size of each individual’s forefoot varus. | Mean power production, maximum power production, and anaerobic fatigue index. | Non-randomised, repeated measures, non-controlled study. | No significant difference in mean power production, maximum power production and anaerobic fatigue index (p = 0.10, p = 0.21, p = 0.24 respectively) between the two conditions. |
Mean age: 24.0 years (±5.0) | ||||||
Mean height: 178.0 cm (±5.0) | ||||||
Mean mass: 79.7 kg (±8.1) | ||||||
Body fat: 10.3% (±3.2) | ||||||
Forefoot varus: 6.1° (±1.7) |