Toe out, angled wedges, stance width - medial knee pain (medial collateral ligament) through injury recovery

Equipment
1

I’ve been recovering from an ankle post-tib injury (overuse running) since December 2020.

3 months on an ankle rehab program and most of my strength is back and although I get some discomfort it’s largely improved (for cycling, not tried running).
During this recovery period (in consultation with a physio overseeing rehab) we added a slight amount more toe out to my foot position, a 3 degree wedge under cleat and widened the stance width.

This was really comfortable for the first couple of months, zone 2 rides up to an hour or so.
My first longer and slightly harder ride last weekend I found I had medial knee pain afterwards for 4 days (appears to be the medial collateral ligament). In part I don’t feel I need the same support as I did.

I can see that all three of the tweaks could be causing the knee pain - normally I would just have a fresh bike fit (cleats and shoes, otherwise happy) but that’s still not possible.

I’m asking the impossible I guess but what would people undo or reduce first? I will try to get some video of my leg movements, which might give me my own answer…

What is really frustrating is if a friend was suffering with this I am pretty sure with a trainer, a mirror, and a bit of tape I could advise in seconds.

2

Is it a varus wedge (bigger on inside) or valgus wedge (bigger on outside)?

I get medial knee pain if I DON’T have a valgus wedge in my shoes. Goes away within a few rides with the correct wedge.

If you put a varus wedge in, and widened your stance, my understanding is that you put a lot more compressive force on the inside of your knee. Hence the pain. Remove one or both and that compression should be less. I think they have similar effects.

3

So in your case I assume your knees go out on upward stroke and a valgus wedge will work to rotate the knee inwards and help alignment - interesting didn’t ever think of it like that.

My wedge is varus, given the above I wonder if it could be rotating the knee out, in combination with a slight toe out and wider stance width that’s too much.