Thursday, May 14, 2009

Hot Foot

My recent DNF at the 12 Hours of Mesa Verde has me digging for a long-term solution to my feet issues. This was certainly not the first time I have had foot pain in an endurance race but it was the first time that the pain got bad enough to stop me from pedaling.

After some research, it is pretty obvious that I am suffering from Metatarsalgia, or what endurance cyclists refer to as "Hot Foot". Precision Bikes has an article that perfectly describes what I am experiencing:

In cycling, it’s known as “hot foot” - a burning pain in the ball of the foot, perhaps radiating toward the toes. Severe cases feel like some sadistic demon is applying a blowtorch.

Hot foot occurs most often on long rides. It may develop sooner or more intensely on hilly courses because climbs cause greater pedaling pressure. The pain results when nerves are squeezed between the heads of each foot’s five long metatarsal bones. These heads are in the wide part of the foot (the “ball”) just behind the toes.

Feet always swell on long rides (more so in hot weather), causing pressure inside shoes that normally fit fine.

Hot foot is actually a misnomer. It’s not heat but rather pressure on nerves that causes the burning sensation. You’ll sometimes see riders squirting water on their pups in a vain attempt to put out the fire.

So what are my options? Here are a few cycling-specific solutions I found:

1) Loosen the shoe straps across the toes

2) Use thinner insoles & socks

3) Re-focus the pressure. Many riders solve hot foot by moving their cleats to the rear by as much as 8 mm. Long-distance enthusiast may go back as far as the cleat slots allow. They might even drill new rearward holes. After using this remedy, lower your saddle by the same amount if you moved your cleats backward 2-4 mm. If more than 4 mm, lower the saddle about half the amount. So, if your cleats go back 1 cm, put the saddle down 5 mm.

4) Add metatarsal buttons. These foam domes are placed on insoles (or are built into them) just behind the ball of the foot. They spread the metatarsal bones so the nerves running between them aren’t pinched by pressure or swelling. You can find these products in the foot-care section of drug stores.

5) Purchase custom orthotics. These plastic footbeds are supplied by podiatrists or sports medicine clinics. Among their biomechanical benefits are built-in metatarsal buttons. Be certain the practitioner understands you're a cyclist, because orthotics for runners are not what you need. Cycling is a forefoot activity, not a heel-strike activity.

Since I already do what is recommended in #1 and #2, my plan is to try the simple forefoot pad with a metatarsal button (#4) to see if I get any relief from it. If it helps, I may pursue a custom orthodic with the metatarsal pad built into it. eSoles offers a cycling-specific footbed that is low volume and has a metatarsal pad option.

As a last resort, I may slide my cleats all the way back but this goes against everything I have read about achieving a proper bike fit.


T-Race said...

Oh good Dave! Looks like you have some options to work with.

Dave Harris said...

Most enduro nuts have faced this at one time or my case, I moved to a shoe size 1 size larger, moved my cleats all the way back, and used Sole footbeds. I've now moved on to the Specialized medium footbed - it has a built in metatarsel button & arch support.

The fit is fairly loose in the toebox. Most of the time I'll have 2 pairs of socks on and it's perfect.

Don't fear moving the cleats back if it comes to that. It is also much easier on your achilles to have rearward cleats. The calves don't contribute squat to overall power - my power *went up* when I taped both my ankles to be immobile when riding with that broken foot a couple years back. That convinced me forward cleats are more tradition than anything many things in cyling!

Kevin said...

I used to have this same problem. I switched MTB pedals from the Egg Beater to the Time ATAC pedals and upgraded my shoes to a stiffer sole. On my road bike I switched from SPD to a look pedal and again upgraded my shoes to a full carbon sole. I did all of this at the same time and it solved the problem.

Lars said...

Hey Dave,
You may have a nueroma, basically what you are talking about is a pinched nerve. I had one back in the day only mine was aggrevated during backcountry skiing-not really convenient. I would have to take my boot off and stuff my glove inside my boot to change positions. Eventually a podiatrist did an outpatient surgical intervention and cut the nerve out. I was off my foot for a couple of days and riding within 5 days. I would certainly try non surgical first but eventually the nerve lays down a protective layer around itself from repeated pinching (at least in my case) and that only worsens the problem. Good luck, let's go for a ride soon.

FixieDave said...

I think the soposed rules of bike-fit do not apply as much when your on the bike for over a few hours... everybody is different and there are factor that can't be measured or accounted for... like dh said do not be afraid of moving your cleats back... good luck getting this figured out..!

Dave said...

Thanks for all of the comments. I think I made some progress today. I slid the cleats back about 1 cm and tried a footbed with a Metataral bump and it felt better. Still a little pain though...but it could be from last weekend.

Grizzly Adam said...

I have similar issues (recall my first day in the AT boots) while riding. However it almost never happens on the MTB, but on longer, climbey road rides it has gotten pretty intense. I moved to a wider shoe (Specialized) and that helped a ton. Combined with a good footbed and remembering to start the ride with the straps a lot more loose than normal has helped alleviate the problem.


Andrew said...

I get severe pain in the 4th toe of my left foot only - never the right. I have tried customer orthotics twice, which is expensive (at least where I live) but the pads compress after just a few months. The second insert (just bought) hasn't really done anything, even though the metatarsal button is very pronounced (i.e. large). I've now moved on to sliding the cleats back a bit, and so far, touch wood, this hasn't affected anything else (knees etc.), and did feel a bit better last weekend. I've already had the problem with two different brands of cycling shoes, so I'll try different pedals next. It's a case of (expensive) trial and error. Good luck to my fellow sufferers!

Jinny said...

thanks for this - I suffered the same on the two hill loops of the IM WI course (80miles total)... the second loop literally I expected to look down and see flames!... I am off to get new pedals and shoes tomorrow... which I hope fixes this as it was torture!

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PapaRegis said...

Thanks for the suggestions on hot foot! Just a big old roadie here in nor Cal whose feet catch fire every summer! Will be trying on some new shoes after work today with hopes that I can cool off!

CW said...

I'm new to road cycling (a year or so) and have had hotfoot ever since especially on the century rides. I've tried bigger and different brand shoes with no luck. Also moving the SPD's back and forth. Trying the inserts next to see if that helps. Thanks so much for this info everyone!

Unknown said...

Visit Steve Hogg Bike Fit. Moving the cleat further back creates more pressure on the ball of the foot as opposed to spreading the pressure between metatarsals.
Heel wedges used with a level 2 arch support tend to work best.
Theory is the arch support better aligns the forefoot and the heel wedge dips pressure 1 to 2 degrees away from the ball of the foot. Again better spreading the load.
They work better than forefoot wedges as they dont take up room in the toe box taking space/pressure of the forefoot.

Hope this helps others out!

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Andy said...

For the first time in over twenty five years of cycling I suffered from the above and the cause was new pedals. Between my various bikes i have either Shimano M323 pedals (SPD one side / flat on the other), M525 (SPD double sided) or A525 (SPD single sided). On my new bike I asked for some A520 to be fitted. First ride out, and it was only twenty miles, ouch and ouch for a couple of days afterwards.

Second ride on the new bike, I changed to pair of M323 I had spare, added a gel type insole to my shoes and no problem at all.

Now most of my pedals or quite old, as are my SPD shoes, but it would be interesting to know if Shimano have changed the height of the SPD clip in relation to the platform the rest of the shoe sit on.


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Willy Watson said...

Let me admit this was an incomparably useful read and experience. Yeah, many of the cyclists have to suffer this "Hot foot' the sever pain just for the lack of proper knowledge of how to use body strength normally while cycling. I just revealed your bike health awareness creating post and impressed with how you explained the whole feet health issue that might be helpful for all the bike junkie. And I appreciate you for suggesting the possible remedy like Loosening the shoe straps across the toes, using thinner insoles & socks, adding metatarsal buttons. That was really great. By the way, you guys here love to ride on peloton bike? Well, do you know how to put on and How to clip in Peloton Shoes? You can read through the tips and guidelines. Perhaps, you won't be disheartened.

BonitaM said...

Foot pain is a common issue for many cyclists. I think lack of proper knowledge of how to manage body strength while cycling and also unfit boot or shoes. Cyclists should choose the best fit and comfortable Sneakers for riding the cycle. The possible remedy you suggested here in this post was totally prasiworthy. I like your brilliant tips and guidelines.