Originally Posted by
timtak
I found that the most important thing is, not that there is a long extender, nor even increasing Q factor, but rather ensuring that ones toes are rotating away from the bike. Extenders encourage and facilitate this outward rotation. But so does a thin washer. I am currently using a 2mm washer on my right pedal axle and attempting to rotate my right heel inwards, towards my BB just a little. This has been enough (together with various types of exercise) to reduce or almost eliminate, my knee pain.
In my own case, for more than VERY casual riding I use a leg whose setup have been adjusted specifically for use with the bike. It is a mess to actually walk on, but for me worked wonders, on bike.
I turned my toe in a good bit such that the heel would always clear the crank arm. I also lengthened the leg in relation to a "walking" leg to facilitate the lack of ankle flexion. It works SUPERBLY in the instance that I don't actually have to walk more than to the subway landing, car, seat in a restaurant.
I have interest in getting a pedal extender for my utility bike such that I can use with my everyday "walking" leg.