Tip 3 - How to Solve Painful 'Hot Foot'

By Fred Matheny for www.RoadBikeRider.com

In cycling, it’s known as “hot foot” -- a burning pain in the ball of the foot, perhaps radiating toward the toes. Severe cases feel like some sadistic demon is applying a blowtorch.

Hot foot occurs most often on long rides. It may develop sooner or more intensely on hilly courses because climbs cause greater pedaling pressure. The pain results when nerves are squeezed between the heads of each foot’s five long metatarsal bones. These heads are in the wide part of the foot (the “ball”) just behind the toes.

My worst case of hot foot occurred on a 3,400-mile, 24-day transcontinental ride. With an average distance of 140 miles per day, no rest days and more than 100,000 feet of vertical gain, my dogs were smoking by the third week.

My RBR partner, Ed Pavelka, remembers being in agony near the end of one 225-mile ride early in his long-distance career. It was his first experience with hot foot, and the problem plagued him that season until he changed to larger shoes. Feet always swell on long rides (more so in hot weather), causing pressure inside shoes that normally fit fine.

“Hot foot” is actually a misnomer. It’s not heat but rather pressure on nerves that causes the burning sensation. You’ll sometimes see riders squirting water on their pups in a vain attempt to put out the fire.

Besides tight shoes, another risk factor is small pedals, especially if you have large feet. Small pedal surfaces concentrate pressure on the ball of the foot instead of spreading it the way a larger pedal will. If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.

Before Ed figured out his shoe-size problem, he tried to solve the pain with cortisone injections. That’s an unnecessary extreme in most cases -- and it’s not fun to have a doctor stick a needle between your toes. Here are several better solutions.

• Adjust shoe straps. It’s the top strap nearest your ankle that stops your feet from slopping around in your shoes. Tighten it as much as necessary, but keep the strap nearest your toes loose for maximum room. 

• Use thinner insoles and/or socks. This will give your feet more room to swell without restriction, especially helpful if your shoes are borderline snug. 

• Re-focus the pressure. Many riders solve hot foot by moving their cleats to the rear by as much as 8 mm. Long-distance enthusiast may go back as far as the cleat slots allow. They might even drill new rearward holes. After using this remedy, lower your saddle by the same amount if you moved your cleats backward 2-4 mm. If more than 4 mm, lower the saddle about half the amount. So, if your cleats go back 1 cm, put the saddle down 5 mm. 

• Add metatarsal buttons. These foam domes are placed on insoles (or are built into them) just behind the ball of the foot. They spread the metatarsal bones so the nerves running between them aren’t pinched by pressure or swelling. You can find these products in the foot-care section of drug stores. 

• Switch to larger pedals, for the reason mentioned above. 

• Buy new shoes. Look for a model with a wider-and-higher toe box, a stiffer sole and an anatomical footbed with a metatarsal button. One model that meets these specs is the Specialized BG, with versions for road and off-road. 

• Purchase custom orthotics. These plastic footbeds are supplied by podiatrists or sports medicine clinics. Among their biomechanical benefits are built-in metatarsal buttons. Be certain the practitioner understands you're a cyclist, because orthotics for runners are not what you need. Cycling is a forefoot activity, not a heel-strike activity.

For more information on hot foot, orthotics and other foot-related issues, see "Andy Pruitt’s Medical Guide for Cyclists," available as an eBook in the online eBookstore at RoadBikeRider.com.

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