Form & Fitness Q & A
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Carrie Cheadle, MA (www.carriecheadle.com) is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University.
Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.
Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+. He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.
Fiona Lockhart (www.trainright.com) is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker.
Eddie Monnier (www.velo-fit.com) is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.
Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.
David Fleckenstein, MPT (www.physiopt.com) is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker.
Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem.They include World and National champions at one end of the performance spectrum to amputees and people with disabilities at the other end.
Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.
Pamela Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison. She did postdoctoral training at Cornell University and is now an assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.
Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.
Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.
Scott Saifer (www.wenzelcoaching.com) has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.
Kendra Wenzel (www.wenzelcoaching.com) is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.
Steve Owens (www.coloradopremiertraining.com) is a USA Cycling certified coach, exercise physiologist and owner of Colorado Premier Training. Steve has worked with both the United States Olympic Committee and Guatemalan Olympic Committee as an Exercise Physiologist. He holds a B.S. in Exercise & Sports Science and currently works with multiple national champions, professionals and World Cup level cyclists.
Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world.
Brett Aitken (www.cycle2max.com) is a Sydney Olympic gold medalist. Born in Adelaide, Australia in 1971, Brett got into cycling through the cult sport of cycle speedway before crossing over into road and track racing. Since winning Olympic gold in the Madison with Scott McGrory, Brett has been working on his coaching business and his www.cycle2max.com website.
Richard Stern (www.cyclecoach.com) is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years
Andy Bloomer (www.cyclecoach.com) is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years.
Michael Smartt (www.cyclecoach.com) is an Associate Coach with Richard Stern Training. He holds a Masters degree in exercise physiology and is USA Cycling Expert Coach. Michael has been a competitive cyclist for over 10 years and has experience coaching road and off-road cyclists, triathletes and Paralympians.
Kim Morrow (www.elitefitcoach.com) has competed as a Professional Cyclist and Triathlete, is a certified USA Cycling Elite Coach, a 4-time U.S. Masters National Road Race Champion, and a Fitness Professional.
Her coaching group, eliteFITcoach, is based out of the Southeastern United States, although they coach athletes across North America. Kim also owns MyEnduranceCoach.com, a resource for cyclists, multisport athletes & endurance coaches around the globe, specializing in helping cycling and multisport athletes find a coach.
Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.
I have persistent numbness in my little finger that sometimes extends to my ring finger/wrist area. It seems to be caused by riding (I ride 150-200 mi/week). On a recent 80 mile ride it led to a weakening of my hand to the point where I could no longer shift gears with the brake lever. When I'm on the bike, I feel "crooked" in my position, as if I have more weight on the problem hand. I am a big rider (6'1" 195 lbs) and thus support a good deal of my upper body weight with my hands. It seems as if the position of my elbow effects this (i.e. locked vs bent). I've tried more padded gloves but that does not seem to make a difference. Apart from time off the bike, do you have any suggestions how to alleviate this?
Scott Saifer replies:
Almost certainly you are compressing your ulnar nerve when you ride. This nerve runs down your forearm, enters your hand through the notch at the base of your palm and carries messages from your pinky and ring finger to your brain. In order to eliminate the numbness and maintain strength, you have to stop compressing the nerve, and there are several ways to do that.
The best thing would be to reduce the weight on your hands. This might be done by moving the seat back or raising the handlebars. Both of these would cause changes in your position that might require other adjustments.
The next best thing would be to simply change your hand position to take the pressure off the notch at the base of the palm. Avoid gripping the bar with much force and move your hand so the bar does not touch that area. If you tend to ride with your wrist bent back, strive to achieve a more neutral position in which your wrist and hand are more a straight extension of your forearm, rather than going off at an angle. Doing this comfortably may also require a change of stem.
Steve Hogg replies:
I think Scott is absolutely on the money re seat set back and bar height. You mention that you feel crooked on the bike. I would just about bet that you have a rotated hip on the numb hand side. This is common and will cause the hip to drop and or rotate forward on every pedal stroke on that side. The body's unthinking response to this challenge to pelvic stability on a bike, is always to thrust forward the shoulder and lock the elbow on that side to brace against this pelvic wobble. The result: the hand on that side is loaded more. This is very common, though the degree of discomfort varies from person to person. Do what Scott suggests but also get a hands-on health professional (physio, chiropractor, osteopath) to assess you and work towards a permanent solution.
I'm a 62 year old competitive cyclist that rides around 5000 miles/year. This year after particularly hard rides for me (100k @ 21 mph e.g.) , I've experienced intense calf soreness, which I can't recall happening before. I'm riding the same bike for the last 4 years with the only change being perhaps cleat placement. I don't get the soreness on shorter (25 miles), faster rides. Do I have a possible fit issue?
Steve Hogg replies:
The health professionals on this site can advise you regarding effective calf stretches and it is a good idea for you to stretch them. You mention that your cleat placement may have changed. Cleats that are too far forward can cause the calves to be worked harder than is ideal. Check out the posts about cleat position from last month. Positioning your cleats as instructed there will minimise unnecessary strain on the calves. If your combination of shoe and pedal does not allow the cleats to be positioned that way, get back to me with your shoe brand, model and size and the type of pedal that you are using.
I've been enjoying the ongoing discussion about KOPS and its associated virtues.
Recently, I started playing with my position because I felt like KOPS had me too far forward. After making small adjustments and riding several days after each change, I find that I am comfortable and relaxed in a position that has me a few cm behind the KOPS ideal. I have no numbness. Arms and shoulders never get tired. Nice aero position. No pain in knee of any kind. Can do the hands off the drops test...etc. So I feel like I've hit the jackpot... except I am worried I am now too far behind the spindle. It is more than 2 cm. I'm using Shimano pedals with zero float cleats.
One of things I've noticed in playing around is that I like to sit far back on my particular saddle. So now I'm worried that I've overdone it. That I've found a great place to sit on my saddle (slightly far back) and that before I figured that out I'd moved my seat back in an effort to find the right fit. In other words -- I've done too much of a good thing.
How far behind the spindle is too far?
Or to be more realistic, how far behind where the alarm bells should go off? It is quite difficult to tell fore/aft saddle adjustment because it is difficult to judge whether or not you end up sitting in the same place on the saddle after you move it. So I guess my other question is?
How can you tell if it is your saddle or the saddle's fore/aft position?
Do riders tend to naturally settle into the most comfortable saddle position (where you'd sit on the saddle even if it weren't on a bike) or do we settle into the best position on the bike even if it is at odds with the saddle?
Steve Hogg replies:
The positives you have found with your positional change are exactly what I have been talking about. There are a few traps however.
1. Once you have unloaded the upper body to a reasonable degree a majority of people can reach further to the bars comfortably. This can be anywhere from a few mm to a few cm. Often though, bar position needs to be reassessed. Slightly higher is common and stem length may need to change.
2. There is no magic number as to know how far behind the pedal axle your knee should be. I stopped measuring this quite a few years ago as I came to believe based on experience, that the number had no relevance other than in a individual sense. Bear in mind that this is a static relationship that we are measuring, but that what we are doing is a dynamic activity. When I did measure for this, the range was between 5 and 50 mm with the majority being between 10 and 25mm. Bear in mind though that this is from a period of 5 plus years ago and that my thinking and practises have evolved and improved since then.
3. If you are too far back 2 things will become obvious. The transition from on the seat pedaling to off the seat sprinting will be ponderous and deliberate rather than near instantaneous. The belly of the hamstrings can get very sore on tough hilly rides and become a limiting factor.
4. Every thing you say seems positive so don't worry unless there is a problem, it is only a number. I'll tell you a story. I used to race against a bloke who was always asking for positional advice in middle of races! I always replied that he looked awful, and that his seat tube angle was too steep. After not seeing him for a few years (I'd started a family) he contacted me and told me that he had bought the largest size Trek OCLV with a 72 degree seat tube angle and wow what a difference, that it looked to him that I had been right all along. He was sure that his position was now good but wanted my opinion. When he came in, and with the help of a Time seat post (no longer available) I moved his seat back another 30 mm again and he was in raptures telling me how powerful and smooth he felt. In fact if I worked out a set of dimensions he would give me a deposit on a custom frame now. When I told him that his effective seat tube angle was 69.5 degrees (he was NOT Joe Average!)his exclamation of ' I can't ride that !' was somewhat at odds with his previous statements. I told him to go away and ride the bike and that as he lived in a hilly area he would soon know the rights and wrongs of the position. I told him to ring me in 4 weeks so I could either tell him how much he owed me, or if he was unhappy ,that he could return the seat post. He rang me later and told me how much better he was riding than ever before but that he did not want to buy a new frame because the seat tube angle did his head in. He is still happily riding his OCLV with the Time seatpost. IT IS ONLY A NUMBER
5. The above does NOT mean that everyone else reading this should go out and shove their seat back as far as they can. If there is one thing that experience has taught me about bike position is that there are only INDIVIDUAL solutions and that any blanket approach is inherently flawed.
6. Another cross check is that if you feel increased leverage, which you will, but that it is only at the expense of losing the ability to spin fast, then you are too far back. If you have it right, you will feel increased leverage which comes from not being able to push harder, but rather from being able to apply force through more degrees of crank movement, and you will be able to spin more smoothly than before.
From what you have told me, it doesn't sound like you have anything to worry about. Should that change, get back to me.
[Dean then responded:]
What is really apparent is how difficult it is to determine what is a great saddle for one's body. For example -- what I'm finding now is that this new position allows me to slide forward for a nice change of muscles every now and then -- even if I'm not hammering. However, the saddle is becoming a limiter now, I think it has too much bend and thus makes it hard to move on it very much without suddenly squishing all the wrong things.
I've done hard hill rides and noticed a nice even feel to my legs afterward, as opposed to "too much quad" which is what I used to feel. I am still using 95 for cadence for most of my long rides so no problems in that area either. Certainly, the further back one goes the cadence does naturally drop a bit, but it seems to me that is simply because the length of the leg lever is longer, yes?
I'll let you know how it feels after a few hundred kms more.
Steve Hogg replies:
Of all the equipment choices we make, the seat is the most personal choice of all. We should be bearing our weight on the middle of the sit bones. Most seats on the market do not allow this unless the nose is 1 - 2 degrees above horizontal. If your seat has sagged noticeably, then it is time for a new seat. Otherwise over time, the lighter shelled seats become hammock like in cross section meaning the rider is forever sliding into the hollow, and as you have experienced, putting pressure on areas not designed to be loaded like that, on the rise out of the dip towards the nose. Of the popular seats, Selle Italia's Flite in its' variants are particularly prone to this over time, though they are not on their own. With the elite riders that I deal with who are Flite users, we lay a straight edge along the top of the seat when new and measure to the lowest point in the upper. This is usually 3 - 4 mm. When this distance increases by more than 2mm, we replace the seat.
As to your last point, I am not sure what you mean as leg length and leg segment length is not going to change once a given person is fully grown. As you move back, you can apply pressure on the pedals for more degrees of the arc of crank movement and this lessens the effect of the ' dead spot ' either side of top and bottom dead centre. At the top of the stroke you can push over the top earlier to some degree, and at the bottom of the stroke you can pull back through it to a degree as well. This means that the transition between ' power' strokes is smoother and less pronounced. If too far back we get to the point where we are getting outside the middle range of hip movement where we have the best control. Additionally, up steeper hills, where the effective seat tube angle is lessened and the relationship with gravity changes, there can be a sensation of pawing forward at the pedal, in that it is difficult to reach the bottom of the stroke with power and control.
That 'nice even' feel of upper leg muscular enlistment that you mention is exactly what we all should be striving for. If anyone usually experiences hammered quads in the belly of the muscles, this almost invariably means that their seat is too far forward.
[Following on from the above discussion, Dean then asked:]
One final question -- but it is a whole can of worms. What about technique?
Watching the Olympic swimmers it is very clear that there is a proper technique to every stroke. This is taught to even basic swimmers... The same is true for most sports, tennis stroke... golf swing...etc. Even counting for some variation, much is discussed in terms of an ideal swing...etc.
Why then is there so little of this about a pedal stroke? Watching Lance Armstrong pedal, wouldn't we all be well served to try and copy him? I realize we all have different muscle strengths and weaknesses... but in every other sport you are still in search of proper technique, even at a beginner level. Why do I read so much about HR and so little about pedal stroke? It seems to me the proper stroke (whatever that is) would yield a tremendous amount of improvement.
Do your thoughts on position come from a search for that? Should I adjust my position to my technique? Shouldn't I really perfect my technique instead?
Steve Hogg replies:
Great question. Firstly, I know next to nothing about the technicalities of swimming but friends of mine who do, say there is a variety of individual styles within what they would call 'correct' technique. So I am not sure how good an analogy you have come up with although I know what you are getting at. It seems to me that there is a much greater range of pedalling technique out there in bicycle land, than there is difference in swim stroke technique.
When you are swimming, for instance freestyle, there are individual differences in structure and function but only one ' position ', ie, prone and more or less parallel to the waters surface. On a bike there are individual differences of structure and function, the differences forced upon a given rider by equipment choices, and the differences forced upon a given rider by the parameters of position that they choose, ie, seat position, cleat position and bar position and their placement relative to each other. This explains the wider variety of pedaling styles out there than swim stroke styles. We as cyclists have more equipment to play with than swimmers.
Now to the relative effectiveness of differing techniques. There are 3 main styles out there; the large middle group who tend to drop their heel in the top half of the down stroke and start to lift it in at some point in the bottom half of the down stroke. I will call this Joe Average. Then there are, at the extremes, the Toe Dippers and the Heel Droppers. Don't misunderstand me here, most people fit into one of these categories but within each there is a spectrum of technique, they are not uniform. The question is, are any of these more efficient than the other?
My answer is no. Here is why. Every attempt that I have seen to train someone to pedal in a particular way (and I'm assuming when I say this that there have been no equipment or positional changes) breaks down as soon as that rider is in a race intensity situation, ie, 90+% heartrate and hurting. Under these conditions riders cannot think about individual strokes and revert to what comes naturally to them. For this reason I think that with the bracketed qualifier above, pedaling technique for an individual is a given. The best way to refine it is to ride a lot and undertake off the bike structural maintenance and improvement so that we function fluidly doing what ever comes naturally to us.
One thing that I have noted though, is differences in seat position fore and aft and seat height are needed for otherwise similarly proportioned people with different styles of pedalling. The extreme Heel Droppers are pushing themselves back in the seat with every stroke under load and so don't need to sit that far back to achieve that passive pelvic stability that I am always rattling on about. Also, the Heel Droppers have to have a lower seat height because their technique causes greater extension of the leg for a given seat height, all other things being equal. They are also using the foot as a secondary lever much more than the Toe Dippers, so I will call the Heel Droppers style ' more leverage, shorter stroke'.
Conversely, the Toe Dippers use their foot less as a secondary lever, can sit noticeably higher because their technique allows them to reach further. Regarding seat position fore and aft, they need to sit further back than the Heel Droppers, because their toe down technique means that the major vector on the pedals is to the rear. This in turn tend to tip their weight forward, and so more seat setback is required to maintain pelvic stability passively. We can call this 'less leverage, longer stroke'.
Most of us however, fit between these extremes in the Joe Average category. Men generally (plenty of exceptions) tend to drop the heel more and women generally(again plenty of exceptions) tend to toe the pedal more.
If you look at the great champions, Merckx was the Heel Dropper, Hinault was Joe Average and Anquetil was the Toe Dipper. They were respectively, the greatest bike rider ever, probably the second greatest, and with Anquetil probably the greatest time triallist ever. They all won 5 Tours de France and were pretty handy otherwise. I think Anquetil won 10 Grand Prix de Nations in something like 14 years, when winning that TT gave you bragging rights as the strongest pro rider on the planet.
In short, my advice to all, is that assuming you are happy with your equipment and position, do what Eddy Merckx is reported to have answered when a boy asked him how to become a World Champion, " ride a lot ".
If we perform an action hundreds of thousand or millions of times as we do when we ride a bike, you can bet that within the constraints of structure and position, we will become very refined at it.
I am a 5'10 135 lb. 28 year old male cat 3/expert level racer. I spend most of my time training and doing races on my road bike, but when I do training or races on my fat tires I don't feel as powerful while pedaling. I have narrowed this feeling down to the difference in Q-factors and different pedals. I am very comfortable on my road setup with Look pedals and Specialized Carbon Pro shoes; but I feel as though when I am on my mountain bike the pedals are a mile apart and there is way too much pedal float. I use Egg Beaters and Specialized Pro shoes on my mountain bike and even with new cleats and shoes it feels like I am standing on ice when I pedal. Are there any other pedals that offer a feel similar to my road setup? Does the wider pedal stance on a mountain bike effect power output (even for extremely narrow hip riders like me) or are there any other tweaks to setting up my mountain bike.
I have the leg extension, knee over spindle distance, and cleat position between the two identical.
Are there any advantages to spending more time than once a week on the mountain bike (on or off-road) to adapt the muscles to the wider position?
Steve Hogg replies:
There are 3 separate issues here.
1. The Q factor of your Mtb cranks is likely to be 24 - 30mm greater than your road cranks depending on what equipment you run. There is nothing you can do about that in the short term.
2. As measured from the crank arm, the centre line of where the cleats engage in your Eggbeaters is another 5 - 6mm wider per side than your Looks. This you can do something about. With SPDs and similar clones, the cleats can be adjusted across the shoe. If you adjust the cleat as far as possible to the outside of the shoe, this will move your feet 4 - 6mm closer to the crank arm per side than the is possible on the Egg Beaters.
3. The amount of freeplay that you don't like. On your Looks, the rubber pad on the cleats means that the quality of the freeplay that the system offers is of the stiffish variety. This can vary depending on how worn the cleat is and the radius of curve in the shoe last where the cleat is attached. I have noticed that with some combinations of Shimano shoes and SPD model PD - M545 (the spud with the large aluminum platform around the pedal body) that the shoe tread blocks partially foul the aluminium cage making it hard to enter the pedal. It is easily resolve by slicing away some of the tread block width. It is a bit fiddly, but if you try this combination, you should be able to come up with the feel you wish to have. I have also noticed that the combination of Sidi Mtb shoes and Ritchey SPD clone (I think Trek sell the same pedal branded Icon) give plenty of freeplay but definitely with a stiff feel.
If you choose to spend the money and do something about this you will still be left with the difference in Q factor between road and Mtb cranks. Usually the transition feels fairly ordinary for anything from a few rides to a week, then most riders become used to the more splay footed, heel in shoe angle this forces upon us. To try and minimise the problem of having to adjust to your Mtb when ever riding, it is probably a good idea to do more training on the Mtb so the feel is less foreign.
As to the power issue, I have only noticed a drop off when on an Mtb, when riders were not used to riding them. With greater familiarity, there doesn't seem, in my experience, to be a large difference.
I am a 40 yr old recreational rider about 150-220 miles/week and my right leg which is my dominant leg is much bigger (quad and calf) and significantly stronger. My hamstrings are always tighter on the left. My legs are anatomically different with the left more bowlegged than the right and my left foot needs a significant heel in posture (at least thirty degrees) which is achieved by kneesavers. I have been fitted for my present bike 3 times by three different people and have never been told I have a pelvic twist or tilt. Any ideas what is wrong and how can it be fixed?
[In answer to some questions Steve asked, Mike replies:]
I have not had a detailed structural assessment. I live in rural North Carolina and have to drive an hour to the nearest bike store. Each fitting I have had has produced bad results such as left quadraceps tendonitis and then iliotibial band syndrome. I sort of gravitate to a position that does not hurt. I have no idea who would do the assessment or where to get one done.
As far as I can tell by measuring myself , the AC joint is the same vertically and anteriorly. No evidence of scoliosis or kyphoidosis. Both iliac crests are the same height and neither anterior. I have never done plain films or CT to determine leg length.
My right arm is about 1.5-2cm longer than my left.
Both legs are bowed but the left much more so. Varus feet, left slightly more so.
When standing with feet shoulder width apart and toes pointing forward and performing a knee bend my left knee will cross the midline and all my weight on the left will be on the medial side of my left foot. In order to prevent this I have to rotate my left foot about 30 degrees outward to keep my knee straight. This is the same setup I have on my bike. A kneesaver is a titanium spacer which is placed between the crank and the pedal to give another 2cm of q factor in order to give my heel clearance and not hit the crankarm or chainstay.
I know the info is incomplete but if you tell me how to get the measurements and what professional would be able to do it or who you could recommend in North Carolina I will certainly get it done.
Steve Hogg replies:
Based on the information you have given me, here is an approach to try. What you have to do is get the foot contacting the pedal in more or less the same plane that the lower leg approaches the pedal platform. Given your bowed leg, this is likely to mean a substantial medial lift under the left cleat or inside the left shoe. Possibly a combination of both, as the degree you have to evert the left foot is likely to be large. Correctly done, this should have the effect of de rotating the leg to a fair degree wihout knee pain. As you live in a rural area, podiatrists with cycling related experience may be thin on the ground. It would be preferable to consult one, but if the self help approach is the only viable one here are a few tips. Start with a generic arch support insole with the greatest amount of eversion you can find. This may have to be modified to some degree for comfort against the foot. They are available here in what we call chemists and what you call drugstores if the business types are a direct comparison. The insole is likely to be not enough. You can add to the medial edge of the insole to increase height. The stuff I use here is an adhesive backed felt that I get from a printers. It is black and comes in 50 metre long by 24mm wide by 3mm thick when compressed rolls. I don't know what it is called as a customer who manages a print shop supplies it to me, but I will find out the name and pass it on.
At some stage you are going to run out of vertical space inside the shoe, particularly in the forefoot. The next step, if you need more eversion, is to start adding Lemond wedges underneath your cleat. I assume you are using clipless pedal. If not something may have to be fabricated. I had a customer some years ago who needed 15 degrees of eversion under one foot and 13 degrees under the other and by following the process described above we got it. Long term however, the wedging was much more secure when he got one piece aluminium wedges machined up to suit.
Your shorter left arm may be adding to the problem by forcing you to twist to that side to reach the bars in the upper and possibly lower body. If this is the case, the basic solution is to pack up the left handlebar and raise the left brake lever to compensate.
At some stage if the opportunity ever presents, get proper structural assessment done. With the knowledge of exactly what the root cause issues are, the solutions are a little easier to come by.