azndude

Hi. I've been having knee pain on the medial (i.e. inside) part of my right knee while riding, for about the last 3 weeks. It happened after I had to switch shoes to get my old ones fixed. But the pain is still there when I use the shoes that got fixed. I get the feeling that my feet are too far apart (i.e. my q-factor is too great). I have adjusted my cleats as far as they will allow so that my feet are as close to the crank as possible. I adjusted the rotation angle of the cleats so that my toes were pointing in and my heel was pointing out, but the physio said this was wrong and rotated the cleats so that my toes were pointing out quite a lot and my heel was close to the crank. I'm using 4.5deg float Look Keos, been riding for about 4.5 years, racing for the first 2.5 of those years. My coach (several years ago) told me to pedal with my knee as close to the top tube as possible. So that's what I did for several years. But recently my physio told me not to do that and just allow my knee to go in its natural position. That seems to have reduced the pain. The pain isn't excruciating, but it's a sharp pain on the inside of my knee that occurs once per downstoke.

Ok, so do you think Q-factor is worth playing around with? My physio said I have narrow hips so it was a good idea to have adjusted the cleats so my feet are as close to the crank as possible. But maybe this is still not close enough. What's the cheapest way to go about reducing the Q-factor? Has anyone experienced anything similar? I'll ask my physio about the Q-factor but I don't see him for another 10 days.

Here's a youtube vid of me pedaling, viewed from the front: https://www.youtube.com/watch?v=6kUKEcKqVdM

dizzy101

Short answer: keep adjusting the things you can easily adjust until your knee feels better. Decreasing Q-factor is not something you can do easily--try to exhaust all the other options first.

I'm confused about these two statements. Is the cleat on the shoe moved inward (to move the toes away from the bottom bracket) or is the cleat on the shoe moved outward (so that the toes move towards the bottom bracket)? It can't be both.

What is your natural standing position? Are you 'toed out'? If so, it makes sense to have your toes slightly outward and your heels slightly inward. I would say that 'toed out' is easier on the knees than 'toed in'.

I think that Q-factor is more relevant to hip and feet discomfort than to knee discomfort. If you feel that there's some discrepancy between your hip width and the distance between your feet--try putting shims in your shoes. But, again, I don't think this has a huge impact on the knee.

Have you varied your saddle height? Have you played with the fore-aft position of the saddle?

FlashBazbo

I would be more concerned about cleat alignment and saddle height than Q factor (or crank length). This doesn't sound like a Q factor issue.

531Aussie

some Lemond Wedges to supinate your feet might be a good idea

AEO

what is likely, is that your feet need one side higher than the other. (rotation)
since lemond is no longer in buisness, specialized offers a good alternative.
for cycling shoes, the wedge will go between the cleat and shoe.

your feet should be parallel to each other and not point at or away from each other, unless your legs are extremely twisted.


I would also look at training your leg muscles so that they are balanced. unbalanced leg muscles cause your legs and knees to twist, resulting in knee pain.

DannoXYZ 

Pain on the inside of the knee typically indicates that your toes are pointed outwards too much. Adjust the cleat to move the heel outward more.

azndude

Thanks for all your replies.

Yeah that's what I thought. But the thing is that when I'm pedaling, my foot will try to rotate so that the heel is as far in as possible. The only thing limiting it is the limited range of float in the cleat. I'm not sure it's a good idea to force my heel out when my natural position seems to be heel-in. Also, if I sit on the end of a high bench and dangle my legs off the edge, my foot naturally seems to point out (toes out, heel in) quite a bit. This suggests to me that I should maintain a heel-in position on the bike.

The cleat is moved laterally to the outside edge of the shoe, to bring my foot closer to the bottom bracket. The cleat is also rotated medially to point more towards the inside edge of the shoe, thus rotating my foot so that my toes point out and my heel points in.


Yeah I think I'm toed out naturally. I also pronate a bit. I have had the saddle height and fore-aft adjusted by the physio and he said it's in the right position.

My foot does feel like it's rotated too far outward (heel too close to crank). But I have tried adjusting the cleats in every possible position, and nothing seems to feel right. Also, today I went for a ride and it didn't feel normal to not bring my knee to the top tube, I think because I have been doing it for so long.

late

Let's go one step at a time. Deal with the pronation.
https://www.bikefit.com/products.php


The ideal thing here would be to see a professional bike fitter.

What you want is your lower leg going precisely up and down like a piston.
My feet toe out, and I pronate and what the bike fitter had me do is to put on
a pedal extender to increase my Q. It worked. After you get the wedges in, experiment with cleat positioning. Try getting as much Q as you can with them.

Think about seeing a pro fitter, seriously.