Ask 220: Pain in the foot

In our first instalment of Ask 220 we tackle a question around foot pain during training and how best to alleviate the problem for a pain-free ride. Send your questions to info@triathlon220.com.au.

Dear 220 Triathlon,

I am hoping you can help me with my problem.

Over the last 12 months I have been training for Melbourne IM – which I recently finished!.

Over the training period I noticed that on long rides my foot (left but at times both) would become unbearably painful. I tried gel insoles, orthotics and changed to another pair of shoes, but it doesn’t help.

What I think happens is that my foot swells and the sole presses on cleats and either causes too much or not enough blood flow to the feet. The pain is unbearable and I have to remove my feet from the shoes to let blood circulate.

I was wondering if this is potentially the shoes I’m wearing (i.e. need more ventilation or different material), is it the structure of my foot and how I can solve it? Riding isn’t much fun at the moment.

Thanks,

Asaf

Dear Asaf,

Congratulations on your Melbourne IM result! I can appreciate your frustration. Pain in the feet can be a real pain in the…foot.

If only the human body were like an electrical circuit. If a light bulb is not working, in most cases it is because the switch hasn’t been turned on. However, issues with the human body are multifactorial – there is never one single cause of a problem impacting your comfort and performance. It is likely that your discomfort will be a result of a couple (or all) of the following.

Shoe width
Narrow fitting shoes compress the foot bones, compromising the nerve and blood supply to the feet. A simple indicator for this is to measure your feet across the metatarsal heads (the ‘balls’ of your feet where the toes join the feet) in bare feet, then remeasure with shoes on. If the width reduces when shod, then you should consider a wider pair of shoes. The same problem can occur when you tighten the straps of the shoes too tightly.

Innersoles
These allow for dissipation of load across the entire foot, rather than solely the bony prominences. Cost effective off-the-shelf models are available (Shimano, Specialized, G8, eSoles) as are more expensive custom options (Cobra 9, Solestar). Make sure that when you insert them into your shoes that they aren’t occupying too much shoe volume (contributing to the above cause).

Cleats
Running the cleats too far forward on the shoes causes all of your leg power to be transferred into the bike using the bony metatarsal heads (causing painful ‘metatarsalgia’ or ‘sesamoiditis’). You should have the cleat positioned so the ball of the foot is forward of the pedal spindle.

Cleat screw length is a very real cause of foot pain, with some of the longer cleat screws (silver Speedplay, Look Keo) protruding well into shoes with a low ‘stack’ height (Bont, Giro, Mavic). Remove your innersole to feel that the screws are not pushing into your feet… if so, replace the screws!

Less obvious causes
Having removed the above common causes of foot pain, should the issue persist you will need to look further afield at the less obvious factors… These should be considered and attended to after review by a professional bike fitter and cycling-focused health professional, or may require on-referral for assessment by a sports physician.

These include one or all of the following:

  •  Does your saddle allow for sufficient blood flow to pass to the legs?
    Is there a neurological (Morton’s neuroma in the foot or lumbar spine radiculopathy) cause?
  • A muscular issue (compartment syndrome)?
  • Or a vascular cause (peroneal artery insufficiency)?

Good luck with your future events, hopefully minus your niggling foot issue!

Best wishes, Blair.

Blair Martin is a physiotherapist and founder of The Body Mechanic, a workshop dedicated to helping Sydney’s triathletes, cyclists and runners hit the start line in one piece.

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