I bent the shifter out a little and rotated it up so even in 1st it is above my foot. To shift I lift my foot off the peg and pull up with my knee or step down as needed. Removing my foot from the peg is awkward and the lack of feeling is a minor problem. For most hillclimbs I cannot shift on the hill. I strongly urge other amputees to take up dirtriding! Unlike almost any other exercise there are no blisters involved. And the view is great! ;)