Triathlon & Cycling Injury PodiatryThree Sports, One Set of Feet
Your feet do not get a rest day between disciplines. They are clipped rigidly to a pedal for hours, then
asked to run a marathon off the back of it. That is why triathletes collect injuries neither pure runners
nor pure cyclists ever see.
Gary Johnstone finished the Ironman World Championship in Hawaii in 9:24 and won his age
group at Geelong 70.3. Matthew Fieldsend is a multiple Ironman 70.3 finisher who
specialises in return-to-run programming after his own lower limb injuries and surgeries. We have done
the distance.
on the bike, every watt you produce squeezes through a forefoot contact patch the size of a business card
Brick
running off the bike loads fatigued, shortened calves at the exact moment tissue tolerance is lowest
No rest
three disciplines means three loads on one set of tissues, with no true recovery day
General guidance drawn from endurance sport injury research and clinical experience. Individual risk varies with training load, cleat and bike setup, footwear, run volume and energy availability.
What is triathlon & cycling podiatry?
Two very different loads, one foot
Triathlon and cycling podiatry is the prevention, diagnosis and treatment of foot, ankle and lower limb
injuries across three disciplines that share a single set of tissues. The swim is kind to feet. The other
two make up for it.
On the bike, your foot is bolted to a rigid pedal and every watt you produce squeezes through a contact
patch the size of a business card, for hours. That is a pressure and nerve problem:
hot foot,
cleat neuroma,
and the knee pain
that follows from a foot fixed in the wrong rotation for five thousand revolutions an hour.
Then you run off it, on legs that are already cooked. That is an impact and overload
problem: Achilles tendinopathy,
shin splints,
plantar fasciitis
and stress fractures.
The brick run - running immediately off the bike - sits precisely where the two categories meet.
A pure runner has one load to manage and a rest day to absorb it. You have three loads and, in a build
week, no genuine recovery at all. So the questions we ask are different: where is your cleat, how sharply
are your bricks stacked, what are you eating, and which shoe were you in when it started. A
biomechanical assessment covers all
three disciplines rather than one. We treat athletes near Port Melbourne, Elsternwick and Williamstown,
from first-time sprint distance through to Kona qualifiers.
The bike does not rest your feet. It just loads them somewhere else.
Is this you?
Recognise your symptoms
Pick the description closest to what you are feeling, and note which discipline it belongs to. These are
the presentations we see week after week in triathletes and cyclists across our Melbourne clinics.
None of these quite fit?
Book an assessment
and we will work it out properly.
About our approach
We treat all three disciplines, because your body does not separate them.
Most triathletes arrive having been treated as runners. The run leg gets examined, the bike gets
ignored, and the injury comes back - because the cleat that was loading the Achilles or compressing
the forefoot never moved.
So we take the whole week. Where your cleat sits fore and aft, and how it is rotated. Saddle height.
Shoe volume, and whether your feet swell on long rides. How sharply your brick sessions are stacked.
What you are eating against what three disciplines are burning. And then, separately, how you actually
run once the bike has emptied your calves.
Gary finished the Ironman World Championship in Hawaii in 9:24 and won his age group at Geelong 70.3;
complex ankle and tendon injuries in endurance athletes are his stated clinical passion. Matt is a
multiple Ironman 70.3 finisher whose own lower limb injuries and surgeries led him into rehabilitation
and return-to-run programming. Neither of us needs a brick session explained.
A biomechanical assessment,
gait analysis and
running assessment
cover the run leg; cleat and shoe review covers the bike. We work alongside Melbourne bike fitters,
triathlon coaches and run clubs, across our Port Melbourne, Elsternwick and Williamstown clinics.
We have raced the distances we treat - Kona, multiple 70.3s, and the marathons that follow them.
Your cleat is a clinical variable, not a fitting detail
A cleat positioned too far forward puts the pedal axle directly under the metatarsal heads - compressing
the nerve between them with every stroke, and forcing the ankle to plantarflex so the calf works through
a long, repetitive range. Rotation that fights your natural foot alignment tracks the knee off its
path, five thousand revolutions an hour. None of this shows up on a running gait assessment. A bike
fitter optimises your position on the bike; we assess the foot bolted to the pedal, its structure, its
rotation and how it tolerates load. If your fit is right and your foot still hurts, that is our end of
the problem, and we are happy to
work alongside your fitter.
Conditions we treat
Common triathlon & cycling injuries
The bike produces pressure and nerve problems. The run produces impact and overload. The brick session
sits between them. Here is what we see, why the sport produces it, and what we do about it.
On the bike
Bike · Forefoot
“Hot Foot” - Burning Forefoot on the Bike
Forty kilometres in, the ball of your foot starts to burn. It builds until you are unclipping and shaking your foot out mid-ride. That is hot foot, and it is a pressure problem: the cleat concentrates your entire pedalling force under the forefoot, the foot swells and spreads over a long ride, and a stiff sole in a tight shoe leaves nowhere for it to go. Nerves and soft tissue between the metatarsals get compressed.
Riders assume it is inevitable on long courses. It is not. It is a fixable combination of cleat position, shoe volume and forefoot support. Read about forefoot pain.
Where hot foot is diffuse burning, a neuroma is specific: sharp burning, tingling or numbness radiating into two adjacent toes, often with the sensation of a pebble under the ball of the foot. On the bike, a cleat positioned too far forward places the pedal axle directly beneath the metatarsal heads, compressing the nerve between them with every stroke. Tight shoes and the swelling of a long ride complete the picture.
Symptoms typically ease the moment you unclip and loosen the shoe, which is a telling clue. It also affects the run leg, where narrow, tightly-laced shoes irritate the same nerve. Read about neuroma and bursitis.
How we help
Cleat repositioning (typically rearward), shoe width and lacing review, metatarsal domes and offloading, custom orthotics, and shockwave therapy where indicated.
Cycling puts your knee through roughly five thousand revolutions an hour, and your foot - fixed to the pedal - dictates the path it travels. Small errors get repeated relentlessly. Cleat rotation that fights your natural foot alignment produces pain at the front or side of the knee; a saddle too low loads the front of the knee, too high strains the back. Then the run leg adds its own load on fatigued muscles.
Because the foot dictates the knee’s path on the bike and its loading on the run, foot posture and cleat setup belong in any serious conversation about triathlete knee pain. Read our guide to knee pain.
How we help
Cleat alignment and float assessment, gait analysis for the run leg, strengthening, and orthoses where foot mechanics load the knee. We liaise with your bike fitter.
The triathlete’s Achilles is loaded from both directions. On the bike, a saddle set too high or a cleat too far forward forces the ankle to plantarflex and the calf to work through a long, repetitive range. On the run, it absorbs impact on already-fatigued muscles.
Pain and stiffness at the back of the heel is worst on the first steps of the day and in the opening kilometre, eases with warm-up, then bites afterwards. Treating endurance athletes with complex ankle and tendon injuries is Gary’s stated clinical passion. Tendons need correctly dosed load, not rest - rest deconditions them and the problem returns. See our guide to Achilles pain.
How we help
Progressive tendon loading, saddle-height and cleat fore-aft review, and shockwave therapy for stubborn cases.
Sharp, stabbing heel pain with your first steps out of bed, easing as you move, returning worse the next morning. Triathletes are prime candidates: high combined training volume, a bike leg that keeps the calf tight, and running shoes pushed well past their useful life because the bike was the priority that month.
It responds very well to treatment, and considerably less well the longer it is left. See our guides to plantar fasciitis and heel and arch pain.
A diffuse ache along the inner shin, tender across several centimetres, during and after running. Triathletes earn it in a particular way: running off the bike on legs whose calves are fatigued and shortened, with compromised mechanics, at the exact moment tissue tolerance is lowest.
It sits on a continuum with tibial stress fracture, and the difference is partly how long you ignore it. If the pain narrows from a broad band to a single point you can cover with a fingertip, treat it as bone until proven otherwise. Read our full guide to shin splints.
How we help
Brick-session load structuring, calf and hip strengthening, cadence work via running assessment, and orthoses where biomechanics contribute.
The run leg supplies the impact; the training plan supplies the volume. Tibial and metatarsal stress fractures are the common ones, and the navicular - at the top of the arch - is the one that ends seasons, with its poor blood supply and deceptive presentation as a vague, deep midfoot ache.
Triathletes carry a specific added risk: low energy availability. Three disciplines burn an enormous amount, and matching intake to that demand is genuinely hard, particularly for athletes chasing race weight. Under-fuelled bone does not remodel properly. Learn more about stress fractures and foot pain.
How we help
Prompt assessment and imaging referral, structured load management across all three disciplines, gait analysis, and referral to a sports dietitian or physician where fuelling is a factor.
This tendon runs behind the inside ankle bone and is the principal dynamic support of your arch, controlling the foot rolling inward on every footstrike. Across an Ironman marathon that is tens of thousands of repetitions, on legs already emptied by 180km of riding.
Pain settles along the inner ankle and arch, and the arch can feel like it is fatiguing and dropping late in long runs. It is frequently mislabelled as a simple arch strain and allowed to progress - a mistake, since untreated it can change foot posture lastingly. Read our guides to tibialis posterior tendinopathy and the related peroneal tendinopathy.
Triathlon is uniquely cruel to skin. You leave the swim with wet feet, ride and run sockless to save transition seconds, and finish a marathon on feet that have swollen a full size. Friction produces blisters fast, toes jam the front of the shoe and bruise the nails, and repeated pressure builds corns and callouses.
A blister at 20km is a race-ending problem, and it is preventable. We will build you a race-day plan rather than tell you not to race sockless. Read about toe pain.
How we help
Race-day blister prevention strategy, safe nail and callus care, pressure offloading, plus shoe sizing and lacing for feet that swell. Recurring nail problems? See ingrown toenail treatment.
When should a triathlete or cyclist see a podiatrist?
Not every niggle needs an appointment. But being able to keep cycling through a run injury is exactly what
lets triathletes ignore one for far too long - and bone does not care that the bike still feels fine.
Stop running, see us urgently
Same-day or next-day assessment
Pain you can cover with a single fingertip
A vague, deep midfoot ache that returns with every run
Pain that wakes you at night, or is reproduced by hopping
Shin pain that has narrowed from a broad ache to one point
A sudden snap at the back of the ankle and no push-off
Numbness in the foot that persists long after you unclip
A second or third bone stress injury in the same athlete
Book within 1 to 2 weeks
Manageable now, expensive to ignore
Burning forefoot that forces you to unclip on long rides
Tingling or numbness radiating into two adjacent toes
Achilles stiffness that warms up but aches that evening
Heel pain that is worst on your first steps of the morning
Knee pain that appears on both the bike and the run
An arch that fatigues and drops in the back half of long runs
Wanting a plan before a race build, not six weeks out from race day
Breaking down in every build is not fragility. It is three loads landing on one set of tissues with no true rest day - and that is a planning problem, which means it is fixable.
Every plan is built around your race calendar, your build phase, your bike setup and your run volume.
A sprint-distance athlete and a Kona qualifier do not get the same plan, and neither gets a plan that
pretends the bike is not there.
1
Assessment across all three disciplines
We look at how you load the pedal and how you load the ground, because for a triathlete those are two different problems arriving in the same foot.
Cleat fore-aft position, rotation and float
Cycling shoe volume, width and how far your feet swell
Discipline-specific orthoses, built separately for bike and run
3
Criteria-based return to run
Rather than a date on a calendar, we give you milestones you have to hit before you add run volume, before you brick, and before you race. Return-to-run programming is Matt’s specialty, and being a triathlete works in your favour here: there is usually a discipline you can keep training while we treat the one that hurts.
Staged run progressions with clear pain rules at each step
Cross-training guidance that does not aggravate the injured tissue
A deliberate reintroduction of brick sessions
Communication with your coach, physio and bike fitter
4
Prevention and race-day performance
Once you are back in full training, the job changes: keeping you there through a build, and getting you to the finish line with feet intact.
Pre-build screening before the biggest weeks arrive
Race-day blister prevention, taping and lubrication strategy
Shoe sizing and lacing for feet that swell across a long race
What we will not do
We will not put you in orthotics because you are a triathlete. Many do not need them, and where a device is
indicated it has to be built for the discipline - a rigid, low-volume cycling shoe and a running shoe
accommodating impact and swelling are not the same environment, and one device dropped into both rarely
does either job well. We will not prescribe rest as a treatment for tendon pain, because rest deconditions
the tendon and the problem returns with your first session back. We will not tell you to stop bricking; we
will tell you to stop stacking them the way you have been. And we will not clear a bone that hurts because
you have entered a race. Tendon and fascia problems can usually be managed while you keep training in
modified form. Bone stress injuries cannot be rushed, and cycling through one is not a workaround. We will
tell you which one you have, not what you would like to hear.
Why Up & Running
Treated by podiatrists who have raced the distance
You should not have to explain what a brick session is, why you cannot simply take six weeks off in
January, or why moving your cleat 4mm matters.
Kona and multiple 70.3s, raced
Gary finished the Ironman World Championship in Hawaii in 9:24 and won his age group at Geelong 70.3. Matt is a multiple Ironman 70.3 finisher. We have been on the wrong end of these injuries ourselves.
We treat the bike, not just the run
Cleat fore-aft position, rotation, float and shoe volume are clinical variables. Most triathletes are treated as runners, and the cleat that caused the problem never moves.
Return-to-run programming
After his own lower limb injuries and surgeries, Matt built his practice around rehabilitation and getting athletes back to running properly. It is the phase most triathletes rush, and it is the one that costs them.
Three loads, one plan
We structure load across swim, bike and run rather than treating the run in isolation. That is the only way to manage an athlete who has no true rest day inside a build week.
Video gait analysis, and we talk to your fitter
A biomechanical assessment covers footstrike, push-off and strength under load. We work alongside Melbourne bike fitters, triathlon coaches and run clubs rather than around them.
HICAPS on-the-spot claims
All major health funds accepted. Claim your rebate instantly at every appointment, at every clinic, with no paperwork and no referral required.
Gary brings 15+ years of sports podiatry and elite endurance experience to the clinic. He has run a 2:39
marathon and finished the Ironman World Championship in Hawaii, and treating endurance athletes with
complex ankle and tendon injuries is his stated clinical passion. His focus is optimising performance
through strength and movement efficiency rather than reaching for a device first, using orthotic therapy
precisely when it is clinically indicated.
Personal achievements
Ironman World Champs Hawaii, 9hr 24min
Geelong 70.3 Ironman 2017, AG 1st place
Marathon 2hr 39min · 10km 33min
VFL Reserves Premiership, Port Melbourne FC
Professional credentials
Consulting Podiatrist, Melbourne Demons AFLW
Consulting Podiatrist, Williamstown FC (VFL)
Member, Australian Podiatry Association
Member, Sports and Exercise Podiatry Australia
AHPRA RegisteredAPA Member15+ Years ExperienceComplex Ankle & Tendon
Matt’s focus is keeping runners and triathletes moving well and pain-free. He helps patients manage
training loads, improve strength and running technique, and prevent recurring injuries. After sustaining
multiple lower limb injuries across his time in the triathlon and football worlds, his own recovery from
those injuries and surgeries led to a lasting interest in injury rehabilitation and return-to-run
programming - which is why he is the person you want structuring your way back to a brick session.
Personal achievements
Multiple Ironman 70.3 finisher
Melbourne Marathon finisher
VAFA Premier Woodrow Medallist
VFL career over multiple seasons
Professional credentials
Accredited Dry Needling Course
SMA conference attendee 2017-19
Regular IOP CPD attendee
Return-to-run programming
AHPRA RegisteredInjury RehabilitationReturn to RunDry Needling
This page was written and clinically reviewed by Gary Johnstone and Matthew Fieldsend, and is maintained by
the Up & Running Podiatry team. It is general information, not a diagnosis.
Book an assessment to get advice specific to your foot.
Explore our services
Services for triathletes & cyclists
Commonly part of an endurance athlete’s treatment plan at our Melbourne clinics.
Three locations across Melbourne's inner west and south. Same-day appointments and all health funds
accepted. Choose the clinic nearest you and book online in under a minute.
The questions we are asked most often by triathletes and cyclists at our Melbourne clinics.
Hot foot is common, but it is not inevitable. It is a pressure problem: your cleat concentrates force under the forefoot, your foot swells and spreads over a long ride, and a stiff sole in a snug shoe gives it nowhere to go.
Cleat position, shoe volume, forefoot support and orthoses all change it. Riders put up with this for years when it is usually fixable.
Hot foot is diffuse burning across the ball of the foot that builds with ride duration. A neuroma is more specific: sharp burning, tingling or numbness radiating into two adjacent toes, often with a pebble-under-the-foot sensation, and it can persist after you stop.
They overlap and both respond to offloading, but the treatment emphasis differs - which is why the distinction is worth making properly rather than guessing.
The two go together, and we are happy to work alongside your fitter. A bike fitter optimises your position on the bike; we assess the foot that is bolted to the pedal - its structure, its natural rotation, and how it tolerates load.
Cleat fore-aft position changes forefoot pressure and Achilles load; cleat rotation changes knee tracking. If your fit is right but your foot still hurts, that is our end of the problem.
Because you are running with compromised mechanics on tissue that is already fatigued - calves shortened from the bike, muscles depleted, at exactly the moment tolerance is lowest.
Brick sessions are essential and worth keeping. What usually needs to change is how sharply they are stacked, the run volume off the bike, and the strength work supporting it.
Sometimes. Cycling is a genuinely useful way to maintain fitness through many soft-tissue injuries, and it is one of the real advantages of being a triathlete.
But it is not a universal workaround. A bone stress injury still needs to heal, and cycling with a compressed forefoot can aggravate a neuroma. Whether it is safe depends entirely on which tissue is injured - which is the argument for getting a diagnosis rather than improvising.
Plenty do, and the transition seconds are real. But wet feet from the swim, plus friction, plus feet that swell across a long race, is precisely how a blister becomes a race-ending problem at 20km.
If you race sockless it needs practising in training and preparing properly - shoe sizing for swollen feet, lacing, lubrication and taping. We will build you a race-day plan rather than tell you not to.
It is a real and under-recognised factor, and triathletes are particularly exposed - three disciplines burn an enormous amount, and matching intake to that demand is hard.
When energy availability is low, bone health, hormonal function and recovery all suffer, and stress fractures become considerably more likely. It affects male and female athletes alike. If you have had recurrent bone injuries, we will raise it and refer to a sports dietitian or physician where appropriate.
Often, yes - because the two shoes and the two loads are completely different. A cycling shoe is a rigid, low-volume environment where the priority is spreading forefoot pressure. A running shoe needs to accommodate impact and a foot that swells.
A single device dropped into both rarely does either job well. Where orthoses are indicated at all - and many triathletes do not need them - we build for the discipline.
Often, and being a triathlete helps - you can frequently maintain fitness in the disciplines that do not aggravate the injury while we treat it.
But the honest answer depends on the tissue. Tendon and fascia problems can usually be managed while you keep training in modified form; bone stress injuries cannot be rushed. We will tell you which one you have, not what you would like to hear.
Triathlon injuries are load injuries spread across three disciplines. Caught early, most are manageable
without losing a season - and there is usually a discipline you can keep training while we treat the one that
hurts. Book with podiatrists who have raced Kona and multiple 70.3s, and who will assess the bike as well as
the run. You will leave with a diagnosis and a plan, not a generic set of stretches.
