PTTD and Cycling: A Safe Way to Stay Active
When you have PTTD, high-impact activities like running can aggravate your symptoms. But that doesn’t mean you have to give up exercise entirely. Cycling is one of the best low-impact activities you can do with posterior tibial tendon dysfunction—it’s easy on your feet while still giving you a solid workout.
Why cycling works for PTTD
Cycling is gentle on your feet because your feet are stabilized on the pedals rather than absorbing the impact of each step. Unlike running, where your body weight repeatedly slams through your arches, cycling lets you control the intensity while keeping your posterior tibial tendon relatively relaxed.
Beyond being easy on your feet, cycling offers real benefits. It maintains cardiovascular fitness without stressing the tendon. It strengthens your legs without heavy load. And it lets you stay active even during flare-ups when walking is uncomfortable.
Setting up your bike
Bike fit matters more with PTTD than it does for most riders. Your foot position on the pedal can either help or hinder your recovery.
Most cyclists do best with their cleats positioned slightly toward the heel. This reduces the work your posterior tibial tendon has to do during each pedal stroke. If you use clipless pedals, consider a slight setback position. If you’re using flat pedals, position your foot so the ball of your foot isn’t pressed hard against the pedal—give yourself room to flex your toes.
Saddle height matters too. If your saddle is too low, your knees work harder and your feet overpronate more. If it’s too high, your hips rock side to side. Both extremes stress the tendon. Aim for a height where your leg is almost fully extended at the bottom of the pedal stroke with a slight bend in your knee.
Indoor vs outdoor
Indoor cycling has some advantages for PTTD. You control every variable—resistance, position, duration. If you have a flare-up mid-ride, you can stop immediately. There’s no traffic, no hills that force you to push harder than planned, and you can easily take breaks.
Outdoor cycling is great too, but be mindful of hills. Climbing puts significant load on your posterior tibial tendon as you push through the pedal stroke. Start with flat routes and gradually add hills as your tendon tolerates them.
Either way, start easy. If you haven’t cycled in a while, begin with 15-20 minute sessions at low resistance and build up gradually.
Tips for pain-free cycling
Listen to your feet. Some mild fatigue is normal, but sharp pain in your inner ankle is a warning sign. If you feel pain during cycling that persists after you stop, cut back your intensity or see a physical therapist.
Consider orthotics in your cycling shoes if you overpronate. Many cycling-specific orthotics exist that provide arch support without crowding your toes.
And don’t forget to stretch afterward. Your calves and Achilles tendon can tighten from cycling, which worsens PTTD. A few minutes of stretching after each ride helps maintain flexibility.
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult with a healthcare provider before starting any exercise program.