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

[Turkle]

My understanding is that those types of surgeries are high risk, low reward. Think of all the pitchers that had careers ended by TOS. I was advised by my doctor not to get a similar surgery if I could avoid it.

In my experience, if you're having nerve issues, the actual underlying problem can be in a wildly unexpected place! It took me about 2 years to find out where the problem was for my arm/hand nerve problems (turned out to be tendinitis in the elbow/triceps area). Might be time to start investigating...

[giordana93]

I would definitely try everything possible before the knife.

I am still trying to find foot happiness. not so much pain, but the whole chain from toes to hips; the number of variables is overwhelming. I like to joke that I need an app to microadjust shoe, arch, cleat placement, etc on the fly as I ride.

But I digress. Was hoping for better news from your foot guy. I would look at arch/foot support--especially metatarsal button options, as well as the foot strapping mechanism. I have long felt that modern shoes have been trending too much towards "wrap around" tightening. almost literal Boa constriction. Another trend I am starting to question is the "stiffer is better" in shoe construction. I find it very interesting that the super-expensive and fitter recommended G8 insoles are literally designed to flex under load at the point of arch support. When I bought my only pair of hockey skates I was willing to splurge on a nicer pair but the sales guy pointed out that the cheaper skates were not as stiff and would be more comfortable than the high zoot carbon models for skaters like me. My recent experience with high end ultra stiff road shoes tends to be similar. An hour or two, no problem, but longer than that....

In short, shoe profiles (flat vs toe drop, width), arch support shapes, and boa/strap placement & tightness should all be explored, especially if it is only on the bike that you get symptoms. try riding with the straps loose. have a fitter or friend with a good eye watch you pedal to make sure there is no idiosyncratic little movement up the chain that might be contributing. A tight hip flexor or something might be there or just a general breakdown of your pedal stroke with fatigue. Think of how tired swimmers slap the water instead of remaining smooth. I know I start mashing more than spinning as I get tired, in spite of being a natural spinner. And my old left knee gets a little creaky, dives inward more, esp. when my saddle height is slightly higher & hamstrings start to tighten up.

[bocobiking]

This has probably been suggested, or you've tried it, but here's my experience. My feet swell when I'm climbing or when I'm riding a longer distance. I just loosen the shoe, often by quite a bit, and I'm good to go.

[odonnebj]

Originally Posted by Turkle

My understanding is that those types of surgeries are high risk, low reward. Think of all the pitchers that had careers ended by TOS. I was advised by my doctor not to get a similar surgery if I could avoid it.

In my experience, if you're having nerve issues, the actual underlying problem can be in a wildly unexpected place! It took me about 2 years to find out where the problem was for my arm/hand nerve problems (turned out to be tendinitis in the elbow/triceps area). Might be time to start investigating...

Agreed. I think the EMG showed where the nerve signal was being impaired hence the "tarsal tunnel" diagnosis.

[djg21]

Originally Posted by 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.

So you have what amounts to metatarsaligia (pain behind the ball of your foot), maybe from nerve impingement that can be caused by wearing shoes that are too narrow and compress your metatarsal bones and the nerves that run through them to your toes.

I’d steer you to a custom shoe and a custom insole. You should check out Don Lamson’s shoes. https://lamsoncycling.com/ The insole will support your foot in a neutral position and can be built with the proper amount of metatarsal support in the needed location. The shoes will fit you perfectly. Check your medical insurance or Flex Spending. Maybe you can get part of the cost reimbursed. They may not be inexpensive, but you get what you pay for — a fully handmade shoe and custom insole that is made for you, and has the fit guaranteed by Don, who has decades of building shoes and ski boots for elite and pro athletes.

Speedplay pedals did pose a problem for me and I had to switch to Look/Garmin after using Speedplays for over 25 years For whatever reason, Speedplays suddenly led to me developing metatarsaglia too. My sense is that they distribute pressure on a much smaller area of the forefoot. I miss the dual-sided entry, but I prefer pain-free feet. And even with bad knees, I’ve never needed the float.

[odonnebj]

This is the region where the nerve signal is impaired on my foot based on the EMG, however the sensation is felt at the ball of my foot /toes region per my doc.

[djg21]

Originally Posted by odonnebj

This is the region where the nerve signal is impaired on my foot based on the EMG, however the sensation is felt at the ball of my foot /toes region per my doc.

Do you pronate significantly? Overpronation can cause the impingement. You definitely should use an insole to neutralize and support your feet. At the very least, it may help.

[2oldTi]

Sharp, knife-like pain in the forefoot most likely due to a Morton's neuroma, rather than tarsal tunnel. I would try wider shoes, loosely laced or buckled. If that doesn't work, a cortisone injection by an orthopedic foot and ankle specialist would be a reasonable next step. If it confers some relief for a while, that confirms the diagnosis of a Morton's neuroma and, if the pain recurs, the definitive solution is surgery. It the injection provides no relief, than either it wasn't in the correct location or it is not a neuroma.

A really good ultrasonographer should be able to image a neuroma with ultrasound. Often a better test than MR (depending upon the radiologist and person doing the ultrasound.

Good luck!

[PTinz]

Late to the conversation here. I too suffered from hot foot, particularly on the left foot, but eventually on the right as well. Was dependent on bike/pedal combo chosen, occurred more quickly on spd pedals, usually between 60 - 90 minutes, with the right foot occurring an hour or so later. On the road bike with larger spd-sl cleats and pedals, the time frame for occurrence would be 2 hrs on the left, three plus on the right.

Here’s what I shared on a shoe fit thread asking about sidi-lake compatibility:

“Plug for G8 insoles here too. Tried the Lakes (the “custom” moldable ones for +/- $75), but didn’t like the fit. Read about G8’s here on the PL and gave them a try, worth the premium price ($125) in my opinion-the metdome inserts were the key for me. They even work on the Lake insoles with a glue gun once the placement is correct. I use the lower stack metdomes for road shoes (cx 237/8’s) using spd-sl pedals, these are 2.5 mm in height. The 5mm ones I use on spd pedal MX 238’s, the higher height, in my mind anyways, helps disperse the concentrated pressure of the spd cleats and pedals, compared to the larger contact patch on spd-sl pedals and cleats.”

The metdomes provided instant relief for my case of hot foot…..they were $35 for two pair from G8 (blue and red, high and low).

Good luck to all that suffer from this!

[downtube42]

I've had this for years. Some things would seem to help for a while, then it would return. I tried all the things discussed.

Three changes recently seemed to have solved the issue. Strange as it sounds, the first was hiking. I bought some Altra wide toe-box hiking shoes and went on some long hikes - the longest about 12 miles - for around 50 miles total. My feet changed. My toes splayed out, and across the ball of my feet it feels different; relaxed is the only way I can describe it. The second change was switching to Lake wide shoes, using the Lake measurement system to pick shoes. Finally, working with a fitter I lowered my saddle significantly.

I think my feet were crushed, my toes were pointed down exacerbating the issue, and my shoes were too narrow.

I've done a couple 200k rides since then, with zero issues.

[odonnebj]

Finally went forth went tarsal tunnel surgery. I'll report back in a few months on the outcome.