Morton’s Neuroma in Cycling: Nerve Pain Between the Toes

Have you ever felt pain or numbness near the ball of your foot or under your toes? Sometimes people describe it as feeling a pebble or a rock underneath their toes.  Others may feel a burning sensation, sharp pain, or numbness.

Morton’s neuroma is a thickening of the tissue around the nerves leading to your toes.  The pain most commonly travels between the 3rd and 4th toe but others experience pain near the ball of their foot or between the 2nd and 3rd toe.  Although the word “neuroma” conjures negative thoughts connecting to cancer, Morton’s neuroma is benign.

 

Causes

  • Tight shoes: high-heeled shoes specifically are a risk factor.  In cycling, shoes are commonly lower volume, which could pinch the toes together for prolonged periods depending on your ride duration.  Considering the number of pedal strokes in a long ride, and the potential amount of massive watts you expend on your local group ride of death, cyclists could be at a higher risk.
  • Foot abnormalities: people with bunions, hammer toes, high foot arches, or flat feet have a higher level of risk to develop Morton’s neuroma than others.
  • Impact: The repeated trauma of your feet pounding the pavement via running also places you at risk.
  • Foot Tilt: An often overlooked aspect in connection to Morton’s neuroma is the tilt of the foot as it relates to the connection with the pedal.  When the foot tilts up to the inside (forefoot varus) in a natural position, more pressure exists on the outer rays of the foot during the pedaling cycle.  This situation occurs in approximately 90 percent of the population.

 

Verification 

If you experience persistent pain, we recommend visiting your healthcare provider to potentially diagnose the issue with a foot examination. They may recommend a foot x-ray to rule out whether you’re experiencing bone problems vs. another instigator.

Solutions

  • Physical therapy: BikeFit trains numerous bike fitters who are also physical therapists.  These extremely knowledgeable fitters specialize in both cycling and neuromuscular injuries.
  • Find better fitting cycling shoes:  Examine the toe-box and fit of your current shoes.  Many people have wide feet and some shoes are extremely narrow.  Although aesthetics in cycling may have led you to your most recent shoe purchase, comfort translates to increased power.  Many companies like Lake, Sidi, Bont and Northwave, produce wider shoes.  Lake produces “normal width” shoes that are already wider than many other companies, and they offer a separate wide sizing selection as well.  Some local bike shops offer specific shoe and cleat fittings.  If you visit your LBS (local bike shop) and request a foot fitting, they must examine the width and tilt of your foot to remedy pain sources.
  • Wedging: Wedging is the solution to the foot tilt issue that causes excessive pressure on the outside of the foot.
A Wedge helps brings pressure under the first two toes, or as you can see from the illustration on the right, wedges spread out the pressure.  This often relieves pain and discomfort.  We strongly suggest that anyone who displays symptoms of Morton’s neuroma should examine the tilt of their feet.

You don’t have to feel pain when you ride.

In The Shoe Wedges or Cleat Wedges?

In The Shoe Wedges

As long as you are talking about BikeFit branded wedges, this is not one wedge against another. Both of the wedge styles offered from BikeFit work extremely well. Each wedge, however, has its place.  In most cases, it’s preferential to use the Cleat Wedge.

When to Use In-the-Shoe Wedges

1.) Cleats not compatible with Cleat Wedges

In the Shoe

 

The In The Shoe (ITS) Wedge often is a “fill in” product for types of cleats that are not compatible with Cleat Wedges like Crank Brothers. However,  Crank Brothers provide a shoe shield (seen on the left) where you can use Cleat Wedges with their cleats.

 

 2.) Hyper-Mobile Feet

A hypermobile foot would be a good place to use an ITS in combination with a Cleat Wedge. This type of foot needs more support. A more rigid foot tends to be more responsive with less wedging and the Cleat Wedge is a better solution for most rigid feet.  This also may be a great option for those who have room in their shoe and would not be affected by the change in volume inherent with the addition of In The Shoe Wedges.

3.) Diagnostics

In-The-Shoe Wedges are also great for diagnostics. If you are looking to determine the effects of wedging on cycling mechanics, ITS Wedges provide the ability to make quick changes.  This also holds true if you are testing out comfort but do not want to take the time to remove your cleats, add cleat wedges, and realign (time saver).  We should mention that this is usually a temporary change.  Once the comfort or mechanics are confirmed, the first choice to correct your foot’s natural angle/tilt is almost always cleat wedges.

In The Shoe Wedges

4.) Fine Tuning

In-The-Shoe Wedges also offer a fine-tuning option for cyclists “in-between” wedge levels or it is tough to tell if 2 cleat wedges or 3 cleat wedges is the better solution. In other words, if 2 or 3 cleat wedges help correct your mechanics and reduce foot pain, try using 2 cleat wedges and add an ITS as the 3rd wedge. Go out on a ride and spend some with the ITS in the shoe and some time with it in your back pocket. Over a period of time, you will usually discover the preferred amount of cleat wedging.  For many cyclists, you may require more than 3 Cleat Wedges.  Since we do not recommend using more than 3, the ITS wedge provides the extra bit of tilt needed!

Why do I Have Foot Pain in my SIDI Bike Shoes?

Concern

“I have been indoor cycling (spinning1) for a year. I love it and do it 2 times a week sometimes 3 or more. Unfortunately, I’m experiencing problems with my SIDI bike shoes.  I love them but I noticed well into the class that I started to develop a pain/soreness etc. As a result, I placed insoles in my SIDI bike shoes and they didn’t provide relief. The soreness resides on the outer side of both my right and left foot–more on the fattier side of your foot aligned. I’m desperately looking for a solution.  If you could help me with some information I would really appreciate it. Thanks.”

Response

Many customers contact us complaining of discomfort or pain on the bottom, outermost part of their foot. The illustration on the left below shows the location of the MOST common “hot foot” or foot discomfort. This seems to hold true with the description mentioned in the question.

sidi bike shoes Foot Pressure Cleat Wedges

The illustration on the right displays even pressure across the entire ball of their foot. Cyclists often describe this as feeling better connected, more stable, even-feeling…etc.

There are 2 ways to look at your own feet and see why there is often more pressure toward the outside of the foot.

Manual Method 

With your knees on a chair, ask someone to hold a book or ruler across the balls of your feet. Are they angled up toward the inside?

Foot Tilt Pedal Wear sidi bike shoesPedal wear foot tilt sidi bike shoes

Foot Fit Calculator

Download the FREE Foot Fit Calculator at the Google Play Store.  The App will walk you through the process (you still need a friend to help) to measure your foot tilt.  Not only will it help you determine foot tilt, but it will also provide you with the solution to your foot pain!  This method is preferred to the manual measurement do to the ability to provide you with the number of cleat wedges you may need to alleviate foot pain.

sidi bike shoes foot fit calculator

sidi bike shoes google play

The Solution

BikeFit provides the solution for you called Cleat Wedges.  They accommodate for your foot’s natural position by creating an angle on your cycling cleat(s) where it connects to the pedal. The number of Cleat Wedges on one shoe in no way dictates the proper number of Cleat Wedges you’ll need on the other shoe.

Each Cleat Wedge contains one degree of slope (or angle) and can be stacked based on your needs (see below for an example of “stacking”).

sidi bike shoes cleat wedges sidi bike shoes wedges

You also mentioned the insoles you tried did not provide relief. That does not mean your insoles are bad but, insoles rarely (if ever) address the tilt of the foot as described above. Consequently, SIDI bike shoes are not the culprit.  Rather (from what you just learned), cyclists experience foot pain in most cycling shoes.

You can order Cleat Wedges by clicking the picture of wedges above or visit a BikeFit Pro or Dealer who carries them.

1Spinning is a registered trademark of Mad Dogg Athletics, Inc.

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