Hot Foot

This is a post by my PT colleague Steve Berkey & Kerri Kramer.
He's developing a cycling clinic in Fredricksburg, VA.

Let’s be honest. Endurance athletes get some twisted satisfaction from
pushing their bodies to the limit. They - or dare I say we - spend hours
demanding more of our bodies so that we can experience the adrenaline
rush crossing yet another finish line that previously seemed unattainable.
We beat ourselves up, and during training in pursuit of the next great race,
aches and pains inevitably arise. After a while, it’s easy to forget what
“normal” workout symptoms are. Some clues: Numbness, tingling, and
burning sensations do not fall within the realm of expected pains, nor are
they safe to ignore. Swimming, biking, and running each have the
potential to wreak neurological havoc on specific regions of the body, but
in this article we will focus on an injury specific to cycling.
In the front of the line, waiting to inflict misery on the long-distance
cyclist, is the infamous “Hot Foot.” Some of you are already well-acquainted
with shooting pain under the ball of the foot, numbness and tingling in the toes,
and that debilitating sensation that someone is pointing a blowtorch at the
bottom of your foot. These unpleasant symptoms, known as metatarsalgia
in the medical world, are typically caused by compression of the interdigital
plantar nerves that run between the bones of the feet (metatarsal heads).
Inflammation of the capsules or bursae at the toe joints, as well as inflamma-
tion of the bones themselves, can place pressure on the nerves of the feet.
It sounds like these inflicted cyclists are in for nothing but trouble. But
wait! It’s not time to hang it up and retire yet. Localized metatarsalgia can
usually be solved with a simple modification to the shoe, pedal, or both. The
trick is to identify the specific cause and address it.
Put the Puzzle Together
Treating “hot foot” is much like solving
a puzzle. The problem most often exists
in the interface between the foot and
the pedal. By following the systematic
process below, “hot foot” can become a
problem of the past.
1. Loosen the shoes: The delicate nerves
and vessels of the forefoot can become
irritated when compressed. By loosen-
ing the straps on the shoes, the nerves
and vessels have room to “breathe.” It
is not uncommon for the foot to swell
after riding longer distances; therefore it
is very important loosen the shoes. For those who prefer the feel of tighter,
more secured straps, another option is to loosen them just during the rest
breaks.
2. Try thinner socks: Another method to increase the space within the shoe
is to wear thinner socks. Experiment with different cycling-specific socks
to alleviate pressure.
3. Adjust the cleat position for clipless pedals: Clipless pedals are great
and a necessity when cycling competitively. They maximize power, but can
also contribute to increased pressure under the forefoot. This can create
“hot foot” for certain types of foot anatomy. Most bicycle fit techniques
recommend positioning the cleat so that the knuckle of the big toe (the
first metatarsalphalangeal joint) lines up with the pedal axle (Figure 1).
Unfortunately, this is not always appropriate.
A simple method to reduce the pressure under the delicate nerves and ves-
sels is to move the cleat back towards the heel of the shoe, approximately
two millimeters. If this doesn’t change the symptoms, move the cleat closer
to the heel, as far back as possible. If you notice any knee pain after this
adjustment, consider a professional bicycle fit. Remember that, if the ad-
justment is large enough, other aspects of the bicycle fit may be affected.
4. Consider specific insoles: Gait patterns differ from person to person.
One pattern is overpronation, or walking more on the inside of the foot.
This movement dysfunction will cause a functional increase of compression
within the shoe while cycling. Using cycling insoles made by Specialized,
Superfeet, and Your Sole can provide additional support and may help al-
leviate “hot foot.”
More info about Steve on 90revolutions.com