Fit and Foot Pain
 

I just posted this in the old thread started by Campag4life "Hot foot, numbness, Mortons Neuroms" but thought I might belong under Fitting Your Bike. Right now at age 61, I have a self diagnosed neuroma in my rt foot that has flared up again with not as severe metatarsal pain in my left. For years I've battled with this including severe ball of foot pain, and the only relief came from changing shoe brands, stretching the shoes, higher and higher arch supports(A la Steve Hogg's suggestion) and metatarsal pads. I've had my cleat back for years and have drilled back my Shimano 3 bolt Look style cleat 2 different positions, but still the pain persists. So now I'm ready to put on the platforms and soft-sole running shoes and met pad and arch support and let my feet recover. I have confusion about whether bike fit such as saddle fore/aft and height really offer a solution vs correct shoes and orthotic. After recovering, I see the following choices:

Spend 375 for a fit and another 170 for a orthotic made for my feet during the fit in DC to Parvilla Cycles, or go to Fitwerx in Vermont which offers similar pricing and orthotic, or go see Jerry Gerlich(one of Steve Hogg's students) in Austin Texas for a even higher price for a fit and a very detailed foot analysis with shims etc. but not custom orthotic

Or, get a D2 shoe for $925 which comes with a custom footbed and then pay $250 for a fit here in Richmond,VA(no fits with custom footbeds here in Richmond). I haven't had a fit with the current bike I have except a on-line video fit, which included a varus analysis through the free Bikefit app.

Or get a $250 fit here in Richmond from a PT who also does bike fits and get the Specialized S-works and do my own orthotic if what comes with it doesn't work. (I'm getting the sof sole highest arch thin fit next week, I have a met pad that works pretty good)

My main concern is that despite several professional fits, my foot pain hasn't gone away, it got better when I found one time my saddle was too far back and the fitter moved it forward.
Steve Hogg is 99% confident that he or one of his students can get me right on the bike so I won't need custom shoes, yet the flight to Texas and the fit would prob equal the cost of the D2. Then again, how long will it take to get the D2 right??

Any thoughts or suggestions would be greatly appreciated!!

I'd go to a good podiatrist for a professional diagnosis and, perhaps, a cortisone shot that may clear up the neuroma for years (going on 25 or so for me) or maybe orthotics done by someone who knows feet inside-out.

Thanks philbob for the suggestion and I'm trying to set up that shot now. Did speak to a PT who runs a bikefit business and he suggested stretching and massage of the foot and especially calf on a regular basis and thought the D2 shoe was a very good idea which will give me an orthotic and a wider shoe. He also thought going to a PT here was a good idea. He also suggested moving the saddle slightly forward and slightly lowering the saddle. (D2 also will give me a fit guide for cleat placement and the owner was a professional fitter and is willing to give saddle adjustment/cleat fit suggestions including skype.)

I'm 72. I went back to cycling at 69, after 11 years off my bike (1973 MKM). The shoes that worked great for me (Puma Touring) had disintegrated, so I embarked on a search for shoes and pedals that work work for me.

The best shoes I tried were Bonts, but the pair I bought was a little too small, and I never could get used to clipping out. They have a custom program.

What I really like the best, though, are pinned flat pedals with Five Ten shoes. The pins in the flat pedals hold my feet very well, and I can move each foot to the right spot at will. I use DMR V12s, but there's a wide selection at virtually all price levels.

If you are interested in a more midfoot riding position than even the latest Speedplays accommodate, start with XL clips and use coupler connector nuts for the additional length you want...

Like this...

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...I've had similar issues that limited my rides to 20 miles or less for about the past year.

A combination of (non-prescription) orthotics from an online supplier of these

https://www.theinsolestore.com/blog/...Footbeds-3.jpg

along with MKS AR-2 road pedals (wider and low profile) and some stretching and custom forming of some Shimano SPD shoes worked for me.

But it took me over a year to figure it out. Anything at all in the cleat position on the shoes (even just the blank rubber plate that comes with the shoes) seems to irritate whatever it is. And I take off some of the sole every now and then with an angle grinder to level it when it wears down on the outside.

I did make a deposit for the D2 custom shoe 2 weeks ago, have yet to receive the FitKit. Makes me wonder about getting custom shoes online, like how long is this going to take and how much back and forth is this going to be??

Currently I'm still riding clipless with the Shimano Wide RP300 and very stretched in the toebox but with Icebug insert and metpad still tight. Appreciate the pinned flat pedals(assume you mean platform pedals?) and FiveTens, I did ride on platform and Shimano hard flat pedal shoe but my feet still hurt. I do have a pair of Bont that I got 6mos ago and molded them and rode them without my met pad and pain, then with orthotic insert and pain, but now going to retry with the insert that came with the shoe and my met pad only and see what happens. The Bont has little toe spring and a straight last, which is how my foot is, straight, not curved. Here's an article which I think every rider who has foot pain should read and is very helpful to me: "Cycling Shoe Surgery". And the video "Neuroma and Natural Foot Health.- You tube" really explains this. The main points are that if the toes are up by a curved up end of shoe and the heel is up, then direct pressure is on the metatarsals(forefoot).

I have been finding relief from my "neuroma" and metatarsal pain in both feet by rolling my foot on a massage ball with soft rubber spikes, stretching the top of my foot by pulling my toes down and especially 3x/day stretching my calves. The bottom of my feet and calfs are hard as rocks!! I'm also wearing altra shoes with no orthotic during the day and just ordered Correct Toes which I plan to wear in whatever shoes I end up cycling in. The site "Natural Footgear" has been a PT educational experience for me as well as advice from a PT.

Bottom line, I might cancel my D2 order and through PT on my feet and lower leg and either the Bont or flat pedal get back to cycling without pain.

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...the nice thing about those SOLE sport shoe inserts is that they have a built in metatarsal button, are relatively thin (don't take up much room in the toe box), and come in a few different arch choices, as well as being a little bit custom moldable.

The AR-2 pedal is not quite as good as a flat platform with pins, but it's pretty good for someone with wider feet (like me) in a road pedal that works to keep your feet more centered in the toe clips.

https://www.benscycle.com/assets/pro...ge/311-112.jpg

Used with mountain/touring toe clips and shoes, they are about as good as anything I've found. For me. ymmv

Physical Therapy has saved my feet!!
I have gone to PT with a therapist who does bike fits and who is an avid road and mtn biker. His assessment of my body found me very Tight from hips down. Though stretching my feet, legs and hips and pointing my toes on my downstroke, my neuroma has disappeared and my foot fatigue and metatarsal pain has virtually disappeared!!
Specifically, several times a day I sit down and grab my foot and grabbing the top of my foot stretch it down, stretching down the ligament from the ankle down to the big toe. Its like sitting down on your knees with your feet down behind you and leaning back. Then I stretch the toes up. Then I do hip flexor stretches, hamstring stretches and calf stretches. The calf and foot stretches have taken the foot pain away. I'm also self-massaging hard the fascia between my toe and met pad over the ball of each foot to help move the pad back down over my metatarsals(it was up near my toes.) I'm also planning on getting the D2 shoe, but now I'm not relying on the shoes to "save my feet" because PT already has.

I like Skyrider1's take on it. I'm always in favor of body modification rather than equipment modification, which so frequently involves chasing a nebulous solution, as we see. For one thing it's free. For another, it's unlikely to do any permanent damage.

I'd also say . . . 95 cruising cadence, 85 climbing cadence. If you don't have the gears for that, get them. That's money that will help a rider perform no matter what the problem. If you can't comfortably run those cadences, that's part of the problem right there.

When I ride, I try to pedal so that I can't usually feel pressure on the ball of my feet during the downstroke. I concentrate on feeling pressure in the heel cup. A good introduction to this concept is getting on your trainer and trying to hold a 120 cadence without bouncing. The trick is to keep your foot flat and pedal with the uppers, so that there seems to be a cushion of air between the bottom of your foot and the shoe sole.

This is also body modification in the realm of neuromuscular coordination. If you can't hit 120, pedal steadily for up to 1/2 hour, no breaks, at the highest cadence you can pedal without bouncing. Warm up and cool down for 15 minutes each. With practice, you'll be able to hold that cadence without going out of zone 2. Itty bitty gears. The idea isn't to produce power or speed, just to teach your legs to go around properly.

I was going to DM you, but realized that I don't have the post count yet. I am from Richmond too, and I was wondering if you could give me the name of the PT/bike fitter? I've been increasing my road miles up to ~40 mile rides and have started to get some knee issues. I am also thinking of switching to clipless pedals and I think that a fit would help with cleat placement, etc.

Sure. Andy Symula PT, Advanced Wellness Centre, Grove and Thompson.

Regarding Carbonfiber's suggestions: I paid out of pocket for my PT exercises and they are now free to you. I've tried high cadence and heel pressure which did help. What really helped me was a combination of:

Cadence, pressing my foot to the end of the shoe on the down stroke, which I did before going to PT. Now I not only do that, but actually focus on pointing my foot down on the pedal stroke which watching the recent Tour many of the riders do. Toe pointing. Having a high, but not too high arch orthotic, a met pad carefully placed below my metatarsals and to the inside of the ball of my foot and a very, very stretched out shoe forefoot helps tremendously.

Thank you very much. I will look Andy up when I get serious about the bike fitting. I have always tried to keep my cadence at least at 90 and no lower than 60 when climbing hills, since I have had some knee issues and surgeries. Maybe I need to up my minimum cadence, though, based on carbonfiberboy's recommendation. The last road ride I took, I focused on my foot placement and toe pointing (even with flat pedals) and it felt pretty good.

My suggestion is to get serious now.

You've become a serious rider, so put out the $$ go get a proper fit and get clipless. It will be worth it many times over. Andrew, not Andy(Manager of Endorphin), is a very experienced fitter at Endorphin Fitness on Patterson. Put out the $250 for a proper fit, get him to suggest pedals, I like 3 bolt Shimano/Look. (use Symula as backup for PT. Your knee pain from cycling is not chronic yet so a good fitter should be able to deal with it)

Clipless will get your foot in position vs having to do it yourself on nonclipless. Its hard to do a mini fit yourself, have to use a level and make sure your bike is level, trainers aren't level. Plus you would need a second person or good (again level) video camera. You should also be reading articles, such as the one on this site on knee pain and there's a good one on Bicycling.com. As you will read stretching quads, hams, calf etc and proper saddle and fore/aft and cleat position are all part of knee solutions.

Ok,I am definitely going to get the fit done and try the clipless pedals. Might need to go with mtb shoes because I use the same bike for longer rides as for ~17mile rt commute (not everyday). Thank you for the advice and encouragement.

I use the widest biggest pedal I can find that way I can use whatever shoe I want, preferably one that is comfortable to walk in too. couldn't be happier. Rivendell has some good deal on wide pedals: https://www.rivbike.com/collections/pedals

So after about 3 pain free months on my "new feet" things went south. Metatarsal pain from the big toe out to my 3rd toe came back not just when riding, but walking. Went to a podiatrist and was scolded for wearing Altra walking shoes as they are designed with having 0 arch, and I have a normal height arch and pronate extensively. Podiatrist thought that the Altra contributed to the pain coming back cycling and walking. So went back to a high arch Brooks Addiction, and while the walking pain cleared up, cycling pain didn't. I have metatarsalgia in both feet. Even pushing the wall swimming hurts. Using the forefoot pushing motion with cleats or flats with toe clips and regular shoes hurt. Have been mtn biking some with flat pedals, but whenever my forefoot is doing the pushing I get forefoot pain. Just ordered the Catalyst Pedal(https://pedalinginnovations.com/) which is very long and uses the whole foot vs forefoot. Will see if that works.

Just a quick followup on my last post: While my "new" PT saved feet went south, remember that I had forefoot pain over 20 plus years. My condition was chronic over several sports, not just cycing. My thought is that if your pain is recent then if you make similar changes I made including orthotic with met-pad, PT stretching, saddle height and fore-aft position and pedal style(toe pointing), then your pain should abate and stay gone hopefully for a very long time.

Re pedals, the more usual approach to this is to use clipless pedals with stiff-soled shoes. SPDs are maybe best for this application, and move the cleats as far aft in the slots as you can. Many people make the slots even longer to move the cleats further aft. Use the heel-on-pedal method to get an initial saddle height with cleats moved back.

Thanks CFB!! I actually have used Speedplay which have a similar size pedal and foot placement to SPD and found that their small pedal pinpointed the pressure more. I have drilled new holes in my Shimano shoes to move my 3 bolt pedals back almost to midfoot with not too much better pressure relief. (pls read 6/19/17 in this post)
The Catalyst pedal is so long that it covers the foot from mid heel to mid forefoot and I'm hoping that is a better solution.

Are you certain about your saddle fore/aft placement? Moving the saddle backwards reduces pressure on the forefoot.

Im of the old toe clip era, they allow you to wear loose fitting shoes with comfortable supportive and often rigid arch supportive insoles.

Thanks for the suggestion Clem! The PT who did the combo fit/PT for $1000 adjusted ht/fore/aft yet perhaps the saddle should be further back and I will recheck that and see what happens if I move it back 1-2mm with my Shimano CT41L shoes and some clipless mtn pedals and see if that makes a difference.
I rode the Catalyst Pedal yesterday for 18 fairly flat miles and also am fine tuning ht/fore/aft position. During the ride my feet felt great and I noticed more use of the glutes as the pedal motion is directed more down to "midfoot" position aka "midcleat" position despite the flat pedals. I noticed much more pressure directed to my heel than forefoot, yet today have noticed overall bottom of foot pain, not localized met pain. Also noticed much more comfort than pushing my foot forward to the ends of the shoe. I used Shimano CT41L shoes with my orthotics, but perhaps I need to try a softer shoe, like my Brooks Addiction.
I truly believe that I have chronic metatarsaligia, and am once again in PT for an arthritic knee and also doing what’s called “neuromuscular retraining “short foot”- basically strengthening my arches by trying to “grasp the floor without excessively curling the toes.” So I’ll see how that does.