Most types of aerobic exercise that involve repetitive leg motion can lead to knee problems if not done correctly. When cycling, the relative alignment of knees and feet during mundane leg motion must be maintained to avoid or minimize knee pain. Continual efforts to find a comfortable foot position on the pedals can lead to more problems. The best bike pedals for bad knees help riders maintain the natural alignment their feet and knees are accustomed to with a minimum of effort.
Pedals
Pedals are made in one of two basic types. Flat pedals and clipless pedals. Flat pedals demand that riders maintain their feet in contact with the pedal. Adding toe clips with straps improves contact to a degree, but does nothing to prevent the foot from slipping off the back of the pedal. Clipless pedal systems don't employ a flat pedal or a toe clip. Special cleats are specific to the clipless pedals and the rider's shoes.
Cleats
The cleat used with clipless pedals attaches to the sole of a cycling shoe and clips into the mechanism on the clipless pedal. With clipless systems, twisting the heel outward disengages the foot from the pedal. Along the way to becoming accustomed to cycling with clipless pedals and cleats, the rider may discover knee pain has reduced.
Cranks
The length of pedal cranks has a direct affect on the mechanism and function of the knee. According to Sheldon Brown, cranks that are too long for a rider cause excessive knee flex. This can lead to pain and injury by causing knees to flex more than they are accustomed to. Consistent with many anatomical-related adjustments, Brown contends that changing the length of pedal cranks no more than a few millimeters makes a difference.
Rider's Evaluation
Pedals that are too far internally rotated cause the knees move in ways that can cause discomfort when riding longer distances. Looking down at your feet as you pedal will disclose if the position of the pedals needs adjusting or if the pedals need to be replaced. Toes should point relatively straight ahead to equalize the forces generated on knees when pedaling. In this regard, clipless pedals improve the alignment of your feet on the pedals.



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