One of the biggest issues facing cycling shops is that of cleat positioning during bike setups. Here are the four most common trends that I see:
– The bike shop sells you the shoes and cleats and expects you to attach them yourself. No advice is given, you get told to simply screw them in.
– The bike shop does a setup but the setup guy has not got the faintest idea of human anatomy, knee and feet injuries or if in fact cleats have anything to do with the aforementioned points.
– The bike shop does a setup and actually gets it right. Trust me, these are far and few between. 
– The customer/cyclist gives up with his/ her bike shop and experiments with his/her cleat position. Ironically this group of people often get their cleats into a far better position than most bike shops manage.
So, herewith a few important points. These are primarily listed to help bike setup practitioners.
1. The fore and aft position is important.
You typically want the centre of the cleat to be positioned near the first metatarsal of the foot. This will ensure maximum power transfer from the foot through to the pedal.
You will want to move the pedal toward the heel in the case of Mortons Neuroma. Cyclists beware, if your so called setup specialist does not know what a Mortons Neuroma is, it’s time to leave and find someone who does.
There are some shoes and products that make allowance for Mortons Neuroma, and should be considered. Advanced setup specialists should also be able to build a metatarsal button to help with the condition. You can read more on this condition here – //sbrsport.me/2012/11/04/curing-mortons-neurona-hotfoot/
2. The in-out position of the cleat is also important.
The cleat goes inward, thus widening the leg stance for conditions such as ITB syndrome and leg valgus conditions.
The cleat moves outward, thus narrowing the leg stance for conditions such as pes anserine bursitis and leg varus conditions. 
3. The heel position.
Turn the heel inward for conditions such as ITB syndrome or tight biceps femoris hamstrings. Recent research suggests a more neutral degree for cyclists suffering with PFPS.
Turn the heel slight outwards for people with tight semi tendinosus and semi membranosis muscles leading to a pes anserine bursitis.
Remember to suggest pedals with approximately 7 degrees play. Your client’s knees will be happy you did.
Here is a bit more information on the our approach to bike setups – //sbrsport.me/2012/07/14/our-approach-to-bike-setup/
Regards,
Mike Roscoe.
Kinesiologist.
