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Technical FAQ: Foot pain, cleat position and more

What can I do about foot pain while cycling?

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I received so much mail about the foot pain issue from last week’s column that I want to use the rest of this week’s column for that topic.

Many people wrote in appreciation, and many wrote to correct what they viewed as poor advice on my part. Paul Swift, the purveyor of Cleat Wedges (, even wrote “Lennard, Lennard, Lennard” as the subject line on his email. So here is a sampling of the comments. I hope you’ll learn something from them; I certainly have.

Dear Lennard,
Just some free professional advice on the numb foot. Runners, bikers, layman, lace or tighten the shoe too much puts undo pressure on a dorsal cutaneous nerve on the top of the foot. Jab your finger into your “funny bone” and hold it for an hour; your fingers will get numb. Also on the foot, sometimes the bone at the base of the metatarsals is slightly enlarged causing even more pressure over that area of the foot. Adding an orthotic might only make the shoe tighter and increase the pressure. Loosen shoes or try a pad under the tongue of the shoe.
Alan, D.P.M.
Foot Care & Surgery Center

Dear Lennard,
I read with interest in your March 4, 2008 column about Rich’s foot numbness problem. I bought a pair of DMT Ultimax shoes a couple of years ago and had the same problem in both feet as soon as I started using the new shoes. I tried a couple of replacement soles until a bike shop owner suggested trying Shock Doctor brand Hockey insoles. I bought them, slipped them in my DMT’s and have never had a problem since.

Dear Lennard,
You have recommended moving the cleats back on the shoe as far as possible for some riders. My question is, should one also lower the seat and/or move it forward, and if so by how much?

Dear Bart,
Yes, you will need to lower the saddle about half the amount you move the cleats. You should, however, not need to change the fore-aft adjustment.

Dear Lennard,
I suffer from pain that is similar to that Rich describes. My podiatrist says that is caused by bursitis. Rich doesn’t indicate that he has
seen a doctor about his problem. Maybe he should.

Dear Lennard,
I have the same problem as Rich. Sometimes the right foot pain and tenderness is so extreme, I can feel the fabric weave of my riding socks digging into my skin. I’ve tried all the usual solutions with no relief: carbon sole shoe, cleat adjustment, support inserts, uric acid test, hydro-cortisone shot. Then a trainer observed that I was walking wrong (too much toe) with my right side, as my body sought a workaround from repeated knee injury on that side. The same mechanics occur during riding, causing the forefoot to be overused and swell. I’m in the painful process of trying to readjust from years of ligament and soft tissue misalignment. But it is helping.

Dear Lennard,
Unfortunately Rich’s symptoms sound all too familiar – I had identical symptoms for years, to the point that I carried a small pack with sneakers and the snap-in insets to ‘rotate’ to give my foot relief. 20 miles in Looks and shoes, 20 miles in sneaks and snap-ins…. I could easily do a century like that and couldn’t do 30 without pain in just one pair.

To cut to the chase, a podiatrist diagnosed a neuroma between two of my toes, and after a bit of minor surgery I’ve never had a recurrence. You might suggest he get a pro to look at his foot instead of the local bike shop.

Dear Lennard,
As a longtime sufferer of foot pain, I read the letter and the attending comments with interest. I have experienced such severe foot pain that after getting off the bike, I was unable to walk for several minutes. I would recommend to anyone suffering foot pain, regardless of localization, to get a referral to a podiatrist, as there are many conditions that can make cycling painful. While moving cleats might help a bit, a custom orthotic combined with some targeted exercises is far more effective in treating pain.

As a result of my consult with a specialist, I ride pain free, and with my cleats positioned in a normal position relative to my forefoot for optimal power transfer. Podiatrists are able to do more than just offer orthotics.

Dear Lennard,
Regarding Rich’s letter about his recurring foot pain, I agree with using a metatarsal button to relieve the pressure in this area of the foot. Specialized produces a full insert with embedded metatarsal button that appears to provide reduced pressure in this area, at least in my two years of limited experience with the product. You might consider this product. Also, if this does not resolve the foot discomfort then seeking appropriate medical advice, either with a podiatrist or internal medicine physician, would be the next logical step to resolve your discomfort.

Dear Lennard,
Rich sounds like a vascular consult in my opinion. The change in color and pain is a sign of exercise-induced ischemia. If I were he, a trip to the doctor to see if this is like Stuart O Grady’s problem, or Ryan Cox.

It sounds very similar to symptoms seen in dysvascular patients.

Finally, here is the note from’s Paul Swift:

Dear Lennard,
Top of the foot and other things to consider: Just a note – remember there is often focus at the bottom of the foot like this guy mentions but, he does not mention tilt (varus or valgus) so then in 90 percent of these cases we must think about the possibility that his cleat fit is not correct.

We never mention the opposite pressure points. If the bottom outside of the foot has pressure then the top inside of the foot may have pressure. (Note: it is tough to get a lot of detail so when he says ball of the foot we think middle of the foot but is that really the case? Not often). If they mention the top of the foot remember that this is more to the inside – or medial aspect – so he is indicating a possible forefoot varus.

The shoe and cleat want to force the foot flat. The foot wants to tilt back to its natural position, which means it pushes up onto the upper part of the shoe.

A – metatarsal arch support pad – as you suggest may only make the pressure worse in this case. Filling up the volume in his shoes clearly does not seem to be the answer or at least the immediate part of his answer.
-Paul Swift