I have a condition called functional PAES, which is caused by the calf muscles compressing the popliteal artery. My doctor recommended activities that would not put much stress on the calves, and while biking may not be ideal, it is much better than walking or running. Do you know tips or techniques to would make me depend less on calf muscles when riding?

The two changes I have made so far are:

  1. Adjusting the seat to be lower than it should be.
  2. Pedaling with the instep of the foot, never with the sole.

Do you agree that those changes will reduce the stress on the calves (even if they make my pedaling more inefficient)?

p.s. PAES is a very rare condition, and it is very hard for me to find support in the real-world in the country where I live, so I have no other choice than figuring out by myself how to live with it. It is definitely possible to change the lifestyle to handle functional PAES, see this ballet dancer case study for example.

  • 1
    Maybe swimming would be even better than cycling? I guess pedaling more with the heel does reduce your usage of the calves. I also wonder whether there is a way you can strengthen your calves without triggering the problem, so that then for a given activity you use your calves less relative to their total strength which would maybe trigger the problem even less?
    – Nobody
    Commented Nov 6, 2016 at 23:38
  • Swimming would be better, but my doctor said cycling was probably okay, and cycling is a lot more practical and fun to me (swimming around here is expensive and the pools are 40ft long, no joke). About strengthening the calves, I would need to be very careful. Overgrown calf usually triggers the condition: PAES is very common in athletes and military people -- in my case it is genetics, I've always had huge calves. On the other hand, maybe "marathonist calves" would improve my condition. Is that what you suggested? Commented Nov 7, 2016 at 0:30
  • 2
    I'm skeptical that lowering the seat more than a little is an appropriate action. Seems to me that a lower seat position makes the thighs less efficient and so there will be a natural tendency to try to compensate with the calves. Commented Nov 7, 2016 at 1:20
  • Do you wish to exercise the legs? Or do you want to get-about on a bike? Are you opposed to a recumbent or even a handcycle?
    – Criggie
    Commented Nov 7, 2016 at 2:12
  • 6
    One other thing you should do is use an easier gear and raise your cadence, so you use less force on the legs for a given energy expenditure. Commented Nov 7, 2016 at 12:26

2 Answers 2


If you are using clipless pedals, then mid-sole cleat positioning is sometimes recommended to triathletes specifically to reduce load on the calves (eg).

I haven't used it myself, but it might be worth a look.

Here is another question discussing mid-foot cleat positioning (with no super clear consensus)

  • Hi Useless. +1 from me: this is pretty much what I was planning to write, but didn't have time to research. Rather than two answers that say the same thing, I'd like to suggest you extend this one to summarize the link, esp why triathletes do it, why cycling shoes and SPD cleats will help, the importance of a bike fit, and the dangers (overlap, toe strike). Let me know if you don't want to ...
    – andy256
    Commented Nov 8, 2016 at 0:26
  • This is also what I was going to say. Interestingly the trend amongst many pro cyclists has also been to push their cleat positions back towards the midfoot, on the grounds that the calf muscles are likely to fatigue faster than the muscles in the upper leg and glutes.
    – John M
    Commented Nov 8, 2016 at 14:18
  • Anyone is welcome to edit details in our provide their own answer: I don't think I'll get round to it today, but will improve later on if no-one else has.
    – Useless
    Commented Nov 8, 2016 at 14:36

If you can try a ride on a crank-forward bike, it might ease your leg aches.

enter image description here

Notice the geometry is quite "chair" rather than bike. Downside is they will be poor at going up a steep hill.

Or consider an electric bike to help take the edge off when your legs do start to ache.

This is more of an assist rather than a replacement power source.

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