Part of this is technique - Training your legs how to pedal a bike. Part of of this could be a bunch of other issue - like toeing in or out your cleats on the pedals to change your knee position. Adding almost an inch on either side of your crank is really pretty extreme (very extreme) and I'd doubt that's the solution. Could be the need for wedges under your cleats to tip your foot like these. Part of it could be your handlebars are too low forcing your torso down over your legs and requiring your knees to move out to provide room. Lots of reasons. The 20mm on a side kneesavers are a likely a bandaid on a different problem. Too, you can do injury to your hips and knees if you move them too far out too.

I'd go to a known good bike fitter with a speedplay pedal fit kit and get it figured out. With the pedal fit kit in concert with the adjustability of the cleats side to side, they can experiment with changing your Q factor and getting it right over an 18mm range per side (13mm on pedal spindles plus an additional 5mm of nominal centered cleat). With the Speedplay zero pedals, they can precisely position the float rotation (toe/heel in or out) to control heel and toe placement. If you still have a pain issue, then I'd think playing with the wedges would be a big part of the answer.

However, none of this should be done until you have good insoles in your shoes. Having the proper arch support in your shoe is absolutely key. The arch anchors support anchors the foot in the shoe and prevents you from sliding around in the shoe as well as giving your foot structure so it doesn't wind up smashed into one part of the shoe where it really shouldn't be. Most (all) cycling shoes have virtually no support and the insoles they provide with the shoe are almost laughable. I've never seen one that was any good. Just like you can't build a building unless you have a good foundation, you need to have your foot properly set in the shoe before you start with a lot of the other stuff.

I really like the Specialized BG insoles that are fit to your arch (high, med, low arch - they have a tool to measure in the store). They work the best for me since I have high arches and they provide good metatarsal support under the front metatarsal arch which, for me, is also key to eliminating foot pain. Another good brand are the moldable Sole ones or Superfeet. Sole and Superfeet are available at REI where you can try them. I like the Sole ones because you can take a heat *** and mold them to your liking - I did that for my mtb shoes and added more metatarsal support to my forefoot which really helped me. You may or may not be comfortable doing that, I have a background in ski boot fitting which is much more complicated and precise than cycling shoes so I was but it's not for everyone.

The other reason to do a bike fit with a pro fitter is simply that they can put you on your bike on a trainer and watch how you pedal from different aspects. You can't do that and as such you'll not be able to have the insight that they would. As well, just because you get your leg measured on the bike statically, doesn't mean that it all changes when you start pedaling. You can slump/slouch, not hold your hips properly rotated etc... and it can change your fit to the pedal (again, part of the technique issue). All of this stuff is interrelated and then overlaid with technique issues.

The problem is solvable but it's likely due to rather subtle issues. In my case it was a combination of q-factor and arch support. Fixing those two issues meant I ditched the wedges I had used under my cleats before and I've ridden now thousands of miles painlessly. It took me a good three years to track it down since most bike shops are not smart about Q factor because most pedal manufacturers don't provide much adjustability. That's starting to change, but right now, Speedplay is the most adjustable by far.

J.