Hot, hot, hot foot (metatarsal / middle toes region)

[odonnebj]

I've been battling "hot foot" for well over a decade now with minimal success. It normally pops up on longer rides (3+ hours) when the weather is "warmer" and in Houston it's basically always on the warm side. It literally feel likes someone is stabbing a hot, shape knife in the metatarsal region of my left foot. In cooler weather though it's less of an issue oddly enough.

Over the years I've slid the cleats back (Speedplay w/ base plate extender), had numerous fits, tried custom footbeds, got wider toe-box shoes, have seen foot doctors, tried toe-spacers, and not much has really swung the pendulum. I thought the toe-spacers were working well until today when it flared up again with avengence.

It really flares up when I'm riding in hillier areas when it's hot out. I'm a spinner by nature on the flats, but that's not always the case in the hills. It does occur in the flats too on longer rides, but it really amplifies in the hills after a few hours. I can stop pedaling, get off the bike, walk around, and there is zero pain after about 15 seconds. It completely disappears. COMPLETELY!
That's all fine and dandy except when I'm in the middle of a long gravel or road race. Can't really stop and smell the roses if I want to compete. Plus, the sensation will eventually pop up again in a short amount of time.

I searched the forum and some posts popped up from several years back. I feel like my case is similar to what others described, but none of the solutions have worked thus far. I wasn't satisfied with the podiatrist I saw years ago. I thought of going again or perhaps inquire about any nerve specialists to trace where the pain may be originating from. Anyway... just wanted to hear what others had to say on the topic for those that have been battling this for way too long.

[Turkle]

I have been battling this too lately.

The problem with moving the cleats super far back is that, for me, it makes me feel like I'm falling forward, and gets super uncomfortable on the upper body. I have since put my cleats back in a more natural position for me.

What's been working for me is actually adjusting my pedal stroke. It flares up on hills, right? Me too. Well, what's happening on hills? You're putting constant pressure on your foot throughout the stroke. What I've been concentrating on doing lately is pulling up just a little bit more so that I'm actually taking the pressure off the bottom of my foot on the up stroke so that there's just a little rest off the nerves in each stroke. Like, actually pressing my foot against the top of the shoe to relieve pressure on the bottom of the foot. Seems to be helping a lot, when I remember to do it.

Does this make sense? I got the idea from "Effective Cycling" by John Forester. Great book.

Interested to hear other thoughts. Also, take my advice for what it's worth, I don't race and I ride about 2k miles per year.

[callmeishmael]

There are some clues here. In hot weather your foot swells. When climbing, there’s more heel drop and more torque. The fact it resolves very quickly off the bike also points to a fit issue. Somehow you’re pressuring the nerves.

Have you a) tried ultra wide shoes (Lake can be good for this) and b) ruled out a neuroma?

[Peter P.]

While you said you tried custom footbeds, have you tried the Specialized Body Geometry insoles? They have a metatarsal button that's supposed to relieve the issue you're having. Since Specialized makes 3 different footbeds with varying degrees of support, you may have to try all three. I don't know if the metatarsal support varies with the model; I just assumed it was the degree of arch support.

[John H.]

1.) What shoes do you wear?
2.) How would you describe your feet? Wide or Narrow? Low or high instep? Bunions? High or low arch? Does arch hold shape?

[odonnebj]

Thanks for the replies everyone! Makes me realize I should have said more in my original post. The more I read now, the more I'm convinced it's metatarsalgia. Here are some responses to everyone's questions:

Shoes: Specialized S-Works 7

Footbeds: Green Specialized (I have high arches). I tried custom footbeds that took up way too much volume in my shoes. I bought the next shoe size up and that did nothing. The Specialized footbeds seem to hold shape. I get the same pain whether new or old footbeds.

Foot Width: Normal (I had too much foot movement in the wide version)

Foot Issues: No bunions, no toe issues, no issues off the bike either

Doctor Impression: One doc said I had a neuroma (10+ years ago) and gave me an injection, however it did nothing. I wasn't convinced I had one though. He did an ultrasound on both feet and there was zero difference from what I was seeing on the screen. I honestly think he just wanted to give an injection and get me out of his office. I haven't been back to a foot specialist since.

[Peter P.]

Find a podiatrist who specializes in sports, or a Certified Pedorthist, and explain your problem. Bring your shoes.

[John H.]

It might be that the Specialized shoes are not for you. They have some interesting design features that work for many but not all riders.
1.) Varus wedge. This is built into the sole. If you don't need this, it can put undue pressure on your 1st metatarsal.
2.) Cant of the sole. Their soles have shape to them. Far from flat. Some feet don't like this (particularly mine). Specialized shoes gave me calf cramps no matter where I put the cleats.

Last thing to add is Speedplay- I know some love them, but they are the least stable pedal, especially for those with sloppy pedaling mechanics and/or excessive foot or knee movement.

My RX would be to try different shoes and Shimano SPD SL pedals.

[Alan]

I have similar but different issues. I have an arthritic joint at the big toe junction. Suggestions by other posters are all good.

Step one - see a podiatrist who knows about cycling. Ask around as usually someone knows of a person in your area. Good fitters know Drs who can help.

Shoes - I have used Spec shoes and am now on flat lasted Vittoria shoes. My fitter preferred the motion of the flat lasted shoes over the canted Spec shoes.

Shoes make a big difference. Think about what stiffness you prefer. Carbon soles are very stiff but can cause foot issues. Giving up some stiffness in a flat lasted shoe is worth a try. Do you have SPD shoes/pedals to try? I do this sometimes. You could try some other shoes such as Sidi or Vittoria shoes that are flat lasted and have less stiff soles and you may be able to find some used to try. I really like the Vittoria shoes as they are very well made and they do custom widths in narrow and wide at not much more cost. PM me if you want more details.

Insoles - I am now on Retul inserts which are custom made and are close to custom orthotics. These are $150 and shops do these. Other insoles to try are G8 which are pricey but they are highly customizable. You can watch youtube videos on them. I am getting some new custom orthotics from a sports podiatrist. Insoles are always a big deal

Pedals - Agree trying different pedals is worth a try. I like Time road pedals but SPD-SL are a good option. Buy new and you can buy them for $70 on Amazon and same thing as expensive models but just heavier. Make sure you have new cleats on any pedal changes as cleats wear. If you borrow pedals to try buy new cleats. If you don't like new pedals they are easy to sell.

Cleat extenders - I ordered the cleat extensions from Midfoot cycling but have not tried them yet. This doesn't seem like your issue but as a last resource may be worth thinking about.

Good luck

Alan

[odonnebj]

Set up an appointment with a foot doc at the end of the month who is also a runner / cyclist. I'll report back.

As another piece of info, I love Specialized shoes since they are canted a bit. I walk more on the outside of my feet / have high arches. Those shoes get my knee in perfect alignment. I'll also say that I walk more like a duck, which is why I use Speedplay pedals. The float adjustment is key to keeping my heels from rubbing the cranks.

[tiretrax]

I usually get the hot foot around mile 60. I haven't been able to get relief despite switching shoe brands, footbeds, cleat position (which caused knee issues). I only put pressure on my foot on the down stroke and lift on the upstroke, so I am interested to see what you find.

[callmeishmael]

Originally Posted by odonnebj

The more I read now, the more I'm convinced it's metatarsalgia.

If that's the case, there's a good argument for getting another doc to have a look, possibly with a view to a cortisone shot.

1 bad doc shouldn't mean you write off the profession/solution.

It's not quite the same, but I saw 3 physios about a chronic hip problem a couple of years back. The first didn't have a clue. The second wanted to refer me to a surgeon. The third said 'you have illipsoas tendinitis. Do these exercises, ease back your mileage, and the problem will go away'. The pain did indeed go away after doing what he said.

Just goes to show...

[odonnebj]

Saw the doc today. He's also a cyclist (Ironman) and recommended surgery for a neuroma. Considering it. Down time is 3 weeks. With my copay it'll be cheaper than new shoes, cleats, footbeds, etc. LOL!

[Peter P.]

Keep the forum informed about your degree of success should you have the surgery.

[odonnebj]

Went and had a second opinion. Ended up getting an EMG nerve conduction study and an MRI. EMG showed some slowed signal along a nerve path, and the MRI showed nothing. As such, the 2nd doc concluded it wasn't a neuroma and that it was tarsal tunnel syndrome instead based on the EMG.

From the interwebs: "Tarsal tunnel release is a surgical procedure that relieves pressure from the tibial nerve. The tibial nerve passes through the tarsal tunnel on the bony bump on the inside of the ankle. The tibial nerve can become compressed and damaged, leading to pain, numbness, and loss of balance."

Not sure what to do or think at this point considering it only happens during cycling when it's hotter out, longer distances, etc.