Antero-posterior position of the cleat for road cycling

  • Published on
    30-Nov-2016

  • View
    214

  • Download
    1

Transcript

  • Science & Sports (2012) 27, e55e61

    Disponible en ligne sur

    www.sciencedirect.com

    ORIGINAL ARTICLE

    Antero-posterior position of the cleatfor road cyclingPositio

    J. Ram

    Centro Doc

    Received 28Available on

    KEYWOEnglish: Cycling;Foot;Lower li

    MOTS CCale ;Vlo ;Pied ;Membres

    CorrespoE-mail a

    0765-1597/$doi:10.1016n antro-postrieure de la cale pour le cyclisme sur route

    os Ortega , P.V. Munuera, G. Domnguez

    ente de Fisioterapia y Podologa, Department of Podiatry, University of Seville, C/Avicena s/n, 41009 Sevilla, Spain

    September 2010; accepted 7 December 2011line 20 January 2012

    RDScleat;

    mb

    SummaryObjective. This work aims at determining the antero-posterior position of the cleat based onvarious morphological characteristics of the cyclists lower limb.Method. Two tests were used to quantify this position: a photograph-based one and aradiograph-based one. Both, the photograph and the radiograph were digitalized to enablemeasurements by means of the software AutoCAD 2006. Two linear regression models wereconstructed from the variables cleat/rst metatarsal distance and tip/cleat distance, whichwere invalidated by the low squared-R coefcient value (0.106 and 0.057, respectively).Results. Participants presented almost constant values of 3.6 0.8 cm for the cleat/rstmetatarsal distance and 0.43 for the tip/cleat distance. As the distance from the base ofthe cleat to the pedal spindle is 3.6 cm, it may be stated that the pedal spindle may coincidewith the head of the rst metatarsal by positioning the base of the cleat at 43% of the lengthof the shoe measured from its distal end. 2011 Elsevier Masson SAS. All rights reserved.

    LS

    infrieurs

    RsumObjectif. Ce travail vise dterminer la position antro-postrieure de la cale sur la base dediverses caractristiques morphologiques des membres infrieurs du cycliste.Mthode. Deux essais ont t utiliss pour quantier cette position : une photo et une radio-graphie de base. Les deux, la photographie et la radiographie ont t numrises an depermettre des mesures au moyen du logiciel AutoCAD 2006. Deux modles de rgressionlinaire ont t construits partir des variables distance cale/premier mtatarsien et dis-tance pointe/cale, qui ont t invalides par la faible du coefcient R (respectivement 0,106 et0,057).

    nding author.ddress: jrortega@us.es (J. Ramos Ortega).

    see front matter 2011 Elsevier Masson SAS. All rights reserved./j.scispo.2011.12.004

  • e56 J. Ramos Ortega et al.

    Rsultats. Les participants ont prsent des valeurs quasi-constantes de 3,6 0,8 cm pour ladistance cale/premier mtatarsien et de 0,43 pour la distance pointe/cale. Comme la distancede la base de la cale laxe de la pdale est de 3,6 cm, on peut dire que la pdale de brochepeut concider avec la tte du premier mtatarsien par le positionnement de la base de la cale

    esus rs

    1. Introd

    The most cthe knee, s[1,2]. Cycliproblems abecause of[3]. Such indown stairsaling. As fafew data rdiscomfortinjury due or latero-mstudies aimthe elemebetween cof the saddare the moedge, thereon the shoalignmentsinto accouna circular pthe shoe/pthe two parlimb does nforces genthat are noAn incorreposterior f

    Shoe/pemission of tso that thetant factorcaused by the authorslongitudinaSome authcidence ofmetatarsalbe with the

    This wo

    to analyzaccordinis, metafrom thethe distaof the cl

    to detertances) i

    onstrtion . Thehe cables

    tho

    rgetplessay (mted

    numed vg beusly)dataticippant4 1r, Nritteprovsity ust thero fepantte eanu eblemerenple,

    thislowe

    samed o

    inchan atism

    sufuringk, ters

    varand 20 d 43 % de la longueur de la chaussure m 2011 Elsevier Masson SAS. Tous droit

    uction

    ommon injuries in the cyclist are those affectingome 25% of all the non-traumatic injuries sufferedsts of any category might be affected, but thesere most frequent among those of a high level,

    the substantial distances they cover in trainingjuries can range from slight discomfort on going

    or after a long ride, to the impossibility of ped-r as the authors are concerned, there have beenecorded during recent years on the incidence of

    in cyclists knees. The most frequent types ofto overloading in cycling result in femoropatellaredial pain in the knee joint [1,35]. Differented at preventing these problems have analyzednts giving the most exact alignment in the tycle and cyclist for each rider [6,7]. The heightle and handlebars, and the length of the crankst common but, according to the authors knowl-

    is no research on the exact position of the cleate. Cycling injuries may also be the result of mis-

    between cyclist and bicycle. It must be takent that the pedal restricts the foot movement toattern in the sagittal plane of motion, and thatedal xing systems do not allow movements ofts in the frontal or transverse planes. If the lowerot describe a normal trajectory during pedaling,erated in pedaling may add loads to the jointst associated to the propulsion of the cycle [8].

    ct antero-posterior position affects the antero-orces of the knee [911].dal interaction is crucial for an effective trans-he forces generated by the cyclist to the bicycle,

    alignment of these parts is considered an impor- in the management and treatment of injuriesoverloading of the knee [12]. Currently, as far as

    are concerned, there is no consensus on the ideall position of the cleat to prevent these injuries.ors refer to an adjustment based on the coin-

    the pedal spindle with the head of the second [9,11,13,14], whereas others claim that it should

    head of the rst metatarsal [7,15,16].rk is designed with the following aims:

    e the exact position of the cleat for each cyclist,g to some variables measured on their feet (thattarsal index, forefoot adduction, the distance

    to cposiblesof tvari

    2. Me

    The tause clisive wcalculato theexpect(ranginprevioThese 44 parparticiof 34.Octobegave wwas apUniver

    It mfeet rathe twparticiseparaMuntecal prothe infto peoaim ofof the of theconsist

    Themore ttraumhavinglimb dals Lookilome

    Thegraph DSC-P1 cleat to the head of the rst metatarsal, andnce from the distal end of the shoe to the baseeat);mine which of the longitudinal variables (dis-s the most important in the adjustment;

    with a resocapacity odistance ofwas restingthat the dire partir de son extrmit distale.ervs.

    uct regression models enabling adjustment of theof the cleat for each cyclist by using these varia-

    null hypothesis of this study is that the positionleat could be the same for all cyclists, as the

    studied do not have any inuence.

    ds

    population of this study consists of cyclists who road bike pedals and practice cycling in an inten-ore than 5000 km per year). The sample size waswith the software nQuery Advisor 4.0, accordingber of variables to relate (between 2 and 5), thealues of the coefcient of multiple correlationtween 0.14 and 0.68 in a pilot study carried out, a value for of 5%, and a 1- power of 80%.

    gave a size of 88 feet. The sample consisted ofants (88 lower limbs: 44 right and 44 left). Sevens were women and 37 were men, with a mean age1.1 years old. This study was carried out duringovember and December 2008. Each participantn consent to take part in the study, and the studyed by the Experimental Ethics Committee of theof Seville.be pointed out that the authors refer always to

    than persons, as the anthropometric variables ofet (right and left) may be different in the same, and in clinical practice the need to perform axamination to each foot is frequent. As Menz andxplained [17], the main conceptual and statisti-s generated by this type of approach arises whences derived from the studies are made in relation

    having used feet as the unit of analysis. As the study is to analyze and relate the characteristicsr limb and the cleat, the authors used feet as unitple, and not the participants. Thus, the samplef 88 feet.lusion criteria were the following: cyclists aged20-years-old [1825], not having suffered severes or surgical operations on the lower limb, not

    fered injuries caused by overloading the lower (at least) the previous year, using automatic ped-and with a sporting intensity of a minimum 5000

    per year.iables were recorded using two tests: a photo-a radiograph. For the rst one, a Cyber-shotigital camera (Sony, San Diego, U.S.A.) was used,

    lution of 5.1 mega pixels and an optical zoom

    f 3x, placed on a tripod at a ground-to-camera 1 meter, completely vertical to the shoe, which

    on the ground and centered on the screen suchstal and proximal ends of the shoe exactly tted

  • Antero-posterior position of the cleat for road cycling e57

    the image frame. The dorsoplantar radiographs were madeusing a Sedecal SPS HF-4.0 X-ray equipment. The X-ray tubehad an inclination of 15 degrees to the vertical [26], anda tube-to-plate distance of 1 meter, according to the cri-teria of the Measurements and Terminology Committee ofthe Americ(AOFAS). Rditions, as [29]. The r10 mAs. Bestudy (theelement aof the shoobtained wimages onSeiko Epsotal image. using the soCalifornia)of the radi[3035].

    The varwere age distance r(centimetethe forefooindex, plustem; 1 Paricleat and between t(%).

    The angthe radioglongitudinaminor tars(Fig. 1) wasfrom the cleat. Howon the phothe distal ethe total le

    Data wfor Windowcal puricaThe Kolmothe data fotest showeuse of parsamples waing on thesample. Lausing the cable in onmodel, anvariables. P < 0.05.

    3. Resul

    The valuesters, of all

    Figure 1 Cleat-rst metatarsal distance.

    the qualitative variable metatarsal index [36,37],were 26 cases of plus index, 60 of minus index, and

    plus-minus index. The shoe size presented minimumaximum values of 39 and 46 respectively (measured

    Figure 2 Tip-cleat distance.an Orthopaedic Foot and Ankle Society [27,28]adiographs were taken under weight-bearing con-this is the constant state of the foot in this sportadiological parameters employed were 65 Kv andcause of the radiotransparency of the piece under

    cleat), it was decided to place a rigid metalt its base to act as a reference in the imagee when xed on the pedal. The radiograph thusas digitalized, using a scanner able to explore

    negative lms (EPSON EXPRESSION 1680 Pro,n Corporation, Nagano, Japan) to create a digi-Measurements were made on the digital image,ftware AutoCAD 2006 (Autodesk Inc, San Rafael,. The protocol of digitalization and measurementographs has previously been used in other studies

    iables studied (and their units of measurement)(years old), gender (male or female), annualidden (kilometers), weight (kilograms), heightrs), body mass index (BMI), angle of adduction oft (degrees), metatarsal index (plus index, minus-minus index), [36,37] shoe size (Paris Point Sys-s point = 6.67 millimeters), distance between thethe rst metatarsal (centimeters), and distancehe tip of the shoe and the base of the cleat

    le of adduction of the forefoot was measured onraphs. It was formed by the intersection of thel axis of the second metatarsal with that of theus [3841]. The cleat/rst metatarsal distance

    also measured on the radiograph, as the distancerst metatarsophalangeal joint to the base of theever, the tip/cleat distance (Fig. 2) was measuredtograph, as the ratio between the distance fromnd of the shoe (tip) to the base of the cleat, andngth of the shoe.ere analyzed by using the software SPSS 15.0s (SPSS Science, Chicago, Illinois). A statisti-tion was performed to detect atypical values.gorov-Smirnov test was used to check whetherllowed a normal distribution; the results of thisd a normal grouping of the data, validating theametric tests. A Student t-test for independents performed on the dependent variables depend-

    side (right-left) to test the homogeneity of thestly, linear regression models were constructedleat/rst metatarsal distance as dependent vari-e model, and the tip/cleat distance in anotherd shoe size and metatarsal index as predictorThe value of P was considered signicant when

    ts

    of age, weight, height, BMI, and annual kilome- participants are shown in Table 1.

    Forthere two ofand m

  • e58 J. Ramos Ortega et al.

    Table 1 Age, weight, height, BMI, and annual kilometers, of all participants.

    N Minimum Maximum Mean SD

    Age (years) 88 19.00 62.00 34.41 11.09BMI 88 18.62 26.99 23.20 1.92Height 88 157 184 172 008Weight 88 52.00 84.00 68.79 7.92Annual km (km) 88 5000 30.000 12470.45 6243.58

    Table 2 Mean, typical deviation, and condence interval to 95% for the quantitative variables.

    Condence interval to 95%Variable Media DT Lower limit Upper limitAdduction of the forefoot (degrees) 13.3 0.4 12.4 14.2Cleat/rst metatarsal distance (cm) 3.6 0.8 3.4 3.7Tip/cleat distance (%) 0.43 0.42 0.43

    as Paris points). Regarding the remaining variables, mean,standard deviation, and lower and upper limits for a con-dence interval of 95% are detailed in Table 2.

    The results of the Student t-test for independent groupson the depleft) did nofor the varnor for the

    The lineffects of able, so thby taking tvariable, adependent

    3.1. Clea

    R and R2 vatively (P = 0yielded the

    of the cleat: rst metatarsal distance = 22.624 + (1.379shoe size).

    ip/

    2 va(P = 0d thf the

    scu

    ositiopmence and gh ne, t

    Table 3

    Model

    Constant Shoe size

    Elements ifor the mo

    Table 4

    Model

    Constant Shoe size

    Elements ifor the moendent variables depending on the side (right andt show signicant differences in the sample, noriable cleat/rst metatarsal distance (P = 0.251),

    tip/cleat distance (P = 0.246).ear regression was intended to illustrate thethe independent variables on a dependent vari-at two models were constructed: one of themhe cleat/rst metatarsal distance as dependentnd the other one taking the tip/cleat distance as

    variable.

    t/rst metatarsal distance model

    lues for this model were 0.326 and 0.106, respec-.002). The linear regression procedure (Table 3)

    following equation to determinate the position

    3.2. T

    R and Rtively yieldetion osize).

    4. Di

    The pdeveloincide[2,42] Althoumachin

    Correlation coefcient. Model 1.Non-standardized coefcients B Typ. Error

    22.624 18.240 1.379 0.431

    n bold are the coefcients of the equation. The rst is the constant and del: rst metatarsal distance.

    Correlation coefcient. Model 2.

    Non-standardized coefcients B Typ. Error

    0.618 0.084 0.005 0.002

    n bold are the coefcients of the equation. The rst is the constant and del: tip/cleat distance.cleat distance model

    lues for this model were 0.238 and 0.057, respec-.025). The linear regression procedure (Table 4)e following equation to determinate the posi-

    cleat: tip/cleat distance = 0.618(0.005 shoe

    ssion

    n of the cleat is a possible risk factor in thent of knee injuries caused by overloading. Theof this type of alteration is approximately 25%the etiology has not been clearly described yet.umerous adjustments exist between cyclist andhere are no accepted scientic criteria for theCondence interval for B to 95%Lower limit Upper limit

    58.884 13.6360.522 2.236

    the second is the coefcient of the shoe size variable

    Condence interval for B to 95%Lower limit Upper limit

    0.450 0.7850.008 0.001

    the second is the coefcient of the shoe size variable

  • Antero-posterior position of the cleat for road cycling e59

    positioning of the cleat. In this work, the authors haveattempted to contribute to establish individualized crite-ria that help adjust the cleat to avoid this type of injuries.Furthermore, the results could be used to establish specicadjustments of the cleat for the rehabilitation of certaininjuries of

    Ericson produced iwas altereone, in whthe secondthe aforemtion gener(ve degreity of the sthe cleat pment of thknee, and cruciate ligcussion of cpedaling wcleat.

    On the othe cleat athe head osized the ithe cleat oby the midmust be poCallaghan monly acceis an alignmpedal spind

    Sanderstar pressurthe resistathe zone cthe hallux.the anteroheight of tity.

    In the pbeen constgraph, andIn the rsmetatarsalshoe size wthe value owas rejectposition ofof metatarfeet, indeppresented distance, wthis type obase of thfor the pothe rst m[43,44], Rudistance frmetatarsalconstant.

    In the second model, based on the tip/cleat distance,it was used the same independent variables (metatarsalindex and shoe size). This model yielded R2 values evenlower than the rst one, meaning that the relative posi-tion of the cleat does not vary with the shoe size. From

    ta of43 aof that c

    .43 (centad ofwithined4%

    ot, td indistaelp suchn) on) [7r prbe tion

    cyculd csonumar or ee wlacia

    becthe

    ranch copositing t

    autas th, or

    s mot neale .

    ncl

    nterod ontantbases sh

    clearsalsuppst mdeteand s to the lower extremity.et al. [9,11,13] studied the changes of momentn the lower limb when the position of the cleatd, and they established two positions: a forwardich the pedal spindle coincides with the head of

    metatarsal, and a rearward one, 10 cm behindentioned one. They found that the forward posi-ated an increase in the dorsiexion of the anklees), in the moments of the ankle, and in the activ-oleus muscle. However, the rearward position ofroduced an increase of seven degrees in the move-e hip, an increase of three degrees in that of thean increase of the stress suffered by the anteriorament. Mandroukas [14] also studied the reper-leat displacements in lower limb, and found thatas more effective with a forward position of the

    ther hand, different authors recommend placingt a position in which the spindle coincides withf the rst metatarsal. Vey Mestdagh [7] empha-mportance of determining the exact position ofn the cyclists shoe because, for the lever formedfoot and rearfoot to be useful, the pedal spindlesitioned beneath the head of the rst metatarsal.[16] and Ruby [15] maintain that the most com-pted position for the foot in relation to the pedalent of the head of the rst metatarsal with thele.on et al. [43,44] analyzed the distribution of plan-es during pedaling, and showed that the morence, the higher the percentage of pressure underomprising the head of the rst metatarsal and

    Moreover, it has to be taken into account that-posterior position of the foot (together with thehe saddle) alters the length of the lower extrem-

    resent work, two models of linear regression haveructed: one based on measurements from a radio-

    the other one based on those from a photograph.t one, the dependent variable was cleat/rst

    distance, and metatarsal index [36,37,45] andere used as independent variables. In this model,f R2 indicated that it was not very useful, so it

    ed, allowing the statement that the longitudinal the cleat will not be affected by either the typesal index [36,37] or the cyclists shoe size. Allendently of the type of metatarsal index [36,37],very similar values for the cleat/rst metatarsalith a mean value of 3.6 0.8 cm (Table 2). Inf pedal, the spindle is always 3.6 cm from thee cleat. This means that there is a constantsition of the cleat with respect to the head ofetatarsal, according to the studies of Sandersonby [15], and Callaghan [16]. There is the sameom the base of the cleat to the head of the rst

    and to the pedal spindle, so it tends to be a

    the dawas 0.effect the cletant 0shoe (the hedance determis at 5rearfobe useexact could hment, positiopositioAnothecould bilitatcertaindon coby Eriposttragreateof a kndromaThis iscleat, ing itsresearin the regardlimb.

    Thetions, of menvariouto casof fempedals

    5. Co

    The adepena consIf the cyclistof themetatamight the rexact posed injurie the variable tip/cleat distance, the mean valuend, as it was conrmed in the rst model thee spindle over the head of the rst metatarsal,an be exactly placed, by multiplying the cons-variable tip/cleat) by the length of the cyclistsimeters), so that the pedal spindle will lay over

    the rst metatarsal. These data were in concor- those obtained by Gonzalez and Hull [46], who

    that the ideal position is that in which the cleatof the length of the shoe measured from thehat is, at 46% from the distal end. This could

    future works to create a scale containing thence from the distal end for each shoe. Thisavoid potential injuries caused by a poor adjust-

    as Quadriceps overloading (due to a rearwardr Gastrocnemius overloading (due to a forward], and excessive tension on knee ligaments [47].actical implication of the results of this studyheir application to help in techniques of reha-

    thus, knowing the position of the cleat for alist, the tension of an damaged Achilles ten-be regulated by using the results of the study

    et al. [48]; or working the dorsiexion of atic ankle by moving the cleat rearward to alesser extent; or helping in the rehabilitationith anterior cruciate ligament injuries or chon-

    patellae, by bringing the cleat forward [49,50].ause, by varying the longitudinal position of thelever arm of the lower limb is altered, chang-ges of movement and muscular actions. Futureuld be aimed at testing whether these variationsion of the cleat would yield the proposed resultshe rehabilitation of injuries in the cyclists lower

    hors consider that this work has some limita-e low number of women in comparison to that

    the use of only one type of pedal, as there aredels available in market. Future works could tryw light on this issue by increasing the numbercyclists, as well as by using different types of

    usion

    -posterior adjustment of the cleat does not the shoe size or the metatarsal index, but it is, according to the results of the present study.

    of the cleat is set at 43% of the length of theoe (measured from the shoe distal end), the baset will be at 3.6 cm from the head of the rst, which coincides with the pedal spindle. Thisly the application of the vectors of the head ofetatarsals on the pedal spindle. By knowing thermination of the cleat position, it could be pro-studied progressive rehabilitative treatments ofthe knee or ankle.

  • e60 J. Ramos Ortega et al.

    Disclosure of interest

    The authors declare that they have no conicts of interestconcerning this article.

    Referenc

    [1] Hannafment ofIn: TeraDeigo:

    [2] Gaston [3] Holmes

    in the corado:

    [4] DAmicthe qua33740

    [5] Bond REWheelm

    [6] Melliontion. Sp

    [7] de Vey mum cy

    [8] Ruby P,foot/pe1993;26

    [9] Ericsonmetric

    [10] Cavanaies of thER, ediHuman

    [11] Ericsonter cycl

    [12] Wheeleoat dknee in11941

    [13] Ericsonmomencycling.

    [14] Mandroment i1990;30

    [15] Ruby P,limb an1992;25

    [16] Callaghcycling.

    [17] Menz Hester sRheuma

    [18] Cheng Jprole Orthop

    [19] Fabry GA followJoint Su

    [20] Kling Jties of 1983;17

    [21] Kumar lower e

    [22] MacEwe1976;60

    [23] Staheli LT, Corbett M, Wyss C, King H. Lower extremityrotational problems in children. Normal values to guide mana-gement. J Bone Joint Surg Am 1985;67(1):3947.

    [24] Wynne-Davies R, Talipes equinovarus. a review of eighty-fourcases after completion of treatment. J Bone Joint Surg Br

    64;46ermoin OrtCreadiogr

    Podith Rport d ankltzma, Kadiogr15.nton ot anationnueritus

    ria demngiterio

    Ciennuer

    the th in07;97nuersamoex. Smngotrussoc 2nuer

    the kle Inadote fooadotince ringeportallux 74;64lladiniology

    Gerrk: Fugel Egle. Jrrari ip bekle Snnafnt of

    in Podnderscling rth A78.ndersd powbutioorts Ses

    ord DR, Moran GT, Hlavec HF. Video analysis and treat- overuse knee injury in cycling: a limited clinical study.uds J, Basham JN, editors. Biomechanics in sport II. SanAcademic Press; 1985. p. 1539.EA. Bikers knees. Bicycling 1977.

    JC, Pruitt AL, Whalen NA. In: USOC, editor. Knee painyclist. First 10 C world congress on sport sciences. Col-Colorado Springs; 1989. p. 2234.o JC, Rubin M. The inuence of foot orthoses ondriceps angle. J Am Podiatr Med Assoc 1986;76(6):.. Murphys law and your legs. The League of Americanan Bulletin 1976; 12(8):2829.

    MB. Common cycling injuries. Management and preven-orts Med 1991;11(1):5270.Mestdagh K. Personal perspective: in search of an opti-cling posture. Appl Ergon 1998;29(5):32534.

    Hull ML. Response of intersegmental knee loads todal platform degrees of freedom in cycling. J Biomech(11):132740.

    MO, Nisell R. Patellofemoral joint forces during ergo-cycling. Phys Ther 1987;67(9):13659.gh PR, Sanderson DJ. The biomechanics of cycling: stud-e pedalling mechanics of elite pursuit riders. In: Burke

    tor. Science of Cycling. Campaign, Illinois 61825-5076:Kinetics Books; 1986. p. 91122.

    MO, Nisell R. Tibiofemoral joint forces during ergome-ing. Am J Sports Med 1986;14(4):28590.r JB, Gregor RJ, Broker JP. The effect of cliplessesign on Shoe/Pedal interface kinetics and overusejuries during cycling. J Appl Biomech 1995;11(2):.

    MO, Bratt A, Nisell R, Nemeth G, Ekholm J. Loadts about the hip and knee joints during ergometer

    Scand J Rehabil Med 1986;18(4):16572.ukas K. Some effects of knee angle and foot place-n bicycle ergometer. J Sports Med Phys Fitness(2):1559.

    Hull ML, Kirby KA, Jenkins DW. The effect of loweratomy on knee loads during seated cycling. J Biomech(10):1195207.an MJ, Phil M. Lower body problems and injury in

    J Bodywork Mov Ther 2005;9:22636.B, Munteanu SE. Radiographic validation of the Manch-cale for the classication of hallux valgus deformity.tology (Oxford) 2005;44(8):10616.C, Chan PS, Chiang SC, Hui PW. Angular and rotationalof the lower limb in 2630 Chinese children. J Pediatr1991;11(2):15461., MacEwen GD, Shands Jr AR. Torsion of the femur.-up study in normal and abnormal conditions. J Bonerg Am 1973;55(8):172638.r TF, Hensinger RN. Angular and torsional deformi-the lower limbs in children. Clin Orthop Relat Res6:13647.SJ, MacEwen GD. Torsional abnormalities in childrensxtremities. Orthop Clin North Am 1982;13(3):62939.n GD. Anteversion of the femur. Postgrad Med(4):1546.

    19[25] Kh

    Cl[26] Mc

    raAm

    [27] Smrean

    [28] SaJRra66

    [29] ReFolic

    [30] Mulimta

    [31] Docrde

    [32] Muofwi20

    [33] Museind

    [34] DoprAs

    [35] MuofAn

    [36] Vilth

    [37] VilQuSp

    [38] Laha19

    [39] PaetIn:Yo

    [40] Enan

    [41] FeshAn

    [42] HameCl

    [43] SacyNo24

    [44] SaantriSp:46476.sh O, Lior G, Weissman SL. Tibial torsion in children.hop Relat Res 1971;79:2531.

    JD, Clark WD, Fann T, Venson J, Jones CL. Effects ofaphic technique on the metatarsophalangeal joints. Jiatry Assoc 1977;67(12):83740.W, Reynolds JC, Stewart MJ. Hallux valgus assessment:of research committee of American orthopaedic footle society. Foot Ankle 1984;5(2):92103.n CL, Brandser EA, Berbaum KS, DeGnore L, Holmestcherian DA, et al. Reliability of standard footaphic measurements. Foot Ankle Int 1994;15(12):

    P. Radiology of the foot. In: Klenerman L, editor. Thed its disorders. 3a ed. Oxford: Blackwell Scientic Pub-s; 1991. p. 259345.a PV. Factores morfolgicos en la etiologa del halluxy el hallus abductus [tesis]. Sevilla: Escuela Universi-

    Ciencias de la Salud; 2006.uez G. Estudio de la protusin metatarsal en el adultos de normalidad [thesis]. Sevilla: Escuela Universitariacias de la Salud; 2006.a PV, Dominguez G, Castillo JM. Radiographic studysize of the rst metatarso-digital segment in feetcipient hallux limitus. J Am Podiatr Med Assoc(6):4608.a PV, Domnguez G, Reina M, Trujillo P. Bipartite hallucalid bones: relationship with hallux valgus and metatarsalkeletal Radiol 2007;36(11):104350.uez G, Munuera PV, Lafuente G. Relative metatarsalion in the adult: a preliminary study. J Am Podiatr Med006;96(3):23844.a PV, Domnguez G, Polo J, Rebollo J. Medial deviationrst metatarsal in incipient hallux valgus deformity. Foott 2006;27(12):10305.

    A. The metatarsals. In: Jahss MH, editor. Disorders oft. Philadelphia: Saunders; 1982. p. 659710.

    A. Anatoma y biomecnica. In: Viladot A, editor.lecciones sobre patologa del pie. 2a ed. Barcelona:r-Verlag Ibrica; 2000. p. 133.

    G, Melillo T, Olinsky D. X-ray evaluation ofabducto valgus deformity. J Am Podiatry Assoc(8):54466.o SJ. Preoperative evaluation of the bunion patient:, biomechanics, clinical and radiographic assessment.bert J, editor. Textbook of bunion surgery. 2a ed. Newtura Publishing Company; 1991. p. 187., Erlick N, Krems I. A simplied metatarsus adductus

    Am Podiatry Assoc 1983;73(12):6208.J, Malone-Lee J. A radiographic study of the relation-tween metatarsus adductus and hallux valgus. J Footurg 2003;42(1):914.ord DR, Moran GT, Hlavac HF. Video analysis and treat-

    overuse knee injury in cycling: a limited clinical study.iatr Med Surg 1986;3(4):6718.on DJ, Hennig EM. In: In-shoes pressure distribution inand running shoes during steady-rate cycling. Secondmerican congress on biomechanics. Chicago; 1992. p.

    on DJ, Hennig EM, Black AH. The inuence of cadenceer output on force application and in-shoe pressure dis-n during cycling competitive and recreational cyclist. Jci 2000;18:17381.

  • Antero-posterior position of the cleat for road cycling e61

    [45] Venning P. Sources of error in the production and mea-surement of standard radiographs of the foot. Br J Radiol1951;24(277):1826.

    [46] Gonzalez H, Hull ML. Multivariable optimization of cyclingbiomechanics. J Biomech 1989;22(1112):115161.

    [47] Gregor RJ, Wheeler JB. Biomechanical factors associated withshoe/pedal interfaces. Implications for injury. Sports Med1994;17(2):11731.

    [48] Ericson MO, Ekholm J, Svensson O, Nisell R. The forces ofankle joint structures during ergometer cycling. Foot Ankle1985;6(3):13542.

    [49] OBrien T. Lower extremity cycling biomechanics. A review andtheoretical discussion. J Am Podiatr Med Assoc 1991;81(11):58592.

    [50] Timmer C. Cycling biomechanics: a literature review. J OrthopSports Phys Ther 1991:10613.

    Antero-posterior position of the cleat for road cycling1 Introduction2 Methods3 Results3.1 Cleat/first metatarsal distance model3.2 Tip/cleat distance model

    4 Discussion5 ConclusionDisclosure of interestReferences

Recommended

View more >