Technical FAQ: Foot pain

Will orthotics help my foot pain?

Dear Lennard,
I’m writing because I just read the shoe review in the VeloNews Buyer’s Guide, and you mention in there that you use a custom orthotic.

I was happy to see that the Shimano SH R300’s I just purchased got high marks, but I am still having issues with my right foot even with the new shoes. I got the new shoes because I was having the problem with my four-year-old Northwave Evolutions.

After 20-30 minutes of riding, outside or on the trainer, the ball of my right foot becomes numb, and the numbness spreads into my toes. On longer rides this escalates into cramping in the foot, and even spreads into my lower leg on occasion.

The shop where I bought the shoes did a lot of work with me to customize the shoes, and I went back after two weeks so they could help with the numbness issue. We decided that my bike fit and shoe fit were good, but what we discovered after riding the trainer was that it appeared that the top of my right foot was more irritated, with swollen blood vessels on the top, than the left.

I stopped pedaling, removed the shoes and socks, and there was significant redness on the right foot, and noticeably less on the left. The straps and buckles on the shoes were tightened evenly, and neither felt overly tight. We pulled out the Shimano insole and replaced it with an off the shelf one in the shop (can’t remember the brand), but that made no difference. The shop’s idea is that I’m getting less blood flow to the right foot than the left, and they suggested the next step is to visit my doctor. Before I take that step, I have a couple questions.

1. Does this sound like an issue that a custom product like Esoles could help?

2. If my amateur diagnosis is correct, is there anything else I should consider to improve blood flow to the foot?

Dear Rich,
My answer to your first question is yes. A custom orthotic is like a gasket, filling the space between the foot and the shoe sole, thereby distributing pressure. I’m not sure that will be enough to eliminate your problem, though, as it sounds like it comes on very soon after starting pedaling.

That brings me to my answer to question No. 2. I strongly recommend that you try shoving your cleat back as far as it will go (and do the other one the same, so you don’t throw off your pedaling).

The cleat mounted further back will result in the pressure of pedaling being transferred up through the shoe behind the metatarsals and into that space behind them that begins the medial arch. Since there is no hard bony area of your foot directly above the cleat, the pressure will instead be spread much more uniformly around the foot by means of that super-stiff Shimano carbon sole.

Finally, you may want to try a metatarsal arch support pad on your custom orthotic to lift and spread the metatarsals to minimize the “hard handshake” pain and swelling between them that could be contributing to your agony.