I've been fighting with knee pain and clipless pedals for quite some time. Eventually I get frustrated and go with flat pedals, only to try clipless again cause I really miss it. Problem is I get knee pain (left knee only) after 30+ mile rides. I never have any knee pain with flat pedals.
I've tried Shimano road clipless. Then I got the +4mm Ultegra pedals. I've also tried Shimano mountain biking pedals/shoes. And two days ago, I bought Speedplay Zero pedals. With all of these, I go on test rides with my tools and try to make adjustments during my rides. I even mess with my saddle. But still have pain in my left knee. I eventually got an appointment for a bike fit, but it got cancelled due to the current pandemic.
The problem is that upon standing naturally, my left foot points out. The attached pic show my foot positioning on a flat pedal during a ride. I need clipless pedals with a longer spindle. The +4mm Shimano wasn't quite enough, so I added a couple of washers to space it out further, But the problem is that there isn't enough play to angle my heel inside. Same issue with the Speedplay, where it allows 15 degrees of play, it's not enough. I need to angle my heel further inside than what Speedplay allows (and I need to find a longer spindle, which has been impossible to find - even from the dealer).
There are solutions for longer spindles, but I haven't found a solution to being able to twist my heel in further. Any advice?
My natural stance on a flat pedal.