I have had hotfoot problems for three years now. It has been a painful and frustrating experience that has threatened to stop me from cycling all together. After working with a local podiatrist who is also a road cyclist, it appears we are finally close to solving the problem. If so, it will be the first time in 3 years I have rode without pain. I am going to write a series of blog posts on my experiences, what I tried to fix the problem, what didn’t work and what I wish I would have done long ago. These posts are not in any way meant to be taken as medical advice, but rather to share my experiences so others that have a similar problem can ask the right questions and get their problem taken care of in a much shorter period of time.
What is Hotfoot?
Hotfoot is a painful condition in one or both feet that some cyclists have. It is often characterized by a painful burning sensation in the ball of the foot area. I also experienced numbness and then outright pain in the ball of foot area. The pain was so bad sometimes that I thought I may have a fracture in my foot. It would be very painful to even press down on the pedals. Often times after I rode, I would have a “pins and needles” sensation in the ball of my foot. I could have numbness for the rest of the day and into the next day. Sometimes when I woke up at night, I would have a painful tingling in the forefoot area.
In the beginning, this pain was mostly just when I rode, but the problems I was having quickly started affecting me off the bike as well. My right foot would hurt to be in any shoes at all, so when I got to work, I would take off my shoes and walk around in socks. Just sitting in a car or at a desk the tingling or pins and needles feeling could start. But on the bike was the worst. The pain would start after riding about 30 minutes and then only get worse. I would loosen the Velcro straps on my cycling shoes which helped a little, but mostly it was just suffering through the miles.
How did all of this start?
My problems started around April 2006. My cycling shoes at the time had worn out, and I purchased a new pair. Its probable that the new cycling shoes contributed to the hotfoot problem. If that contribution was 10% or 90%, it is hard to know. It is very possible something was amiss anyway, and the new shoes magnified an existing problem.
My first thought was that I had a problem with my cleats. I use Look-ARC cleats, so surface area was not an issue (some riders say with smaller cleats, the force of pedaling becomes more concentrated and leads to hotfoot issues). So I moved the cleats back as far as they would go, but this did not help.
My next thought was to simply change shoes. Going back to the original shoes was not an option because they were totally worn out. So I got a third pair of shoes. The third pair of shoes I purposely bought a little bigger to give my foot some more room to breathe. I was also concerned that in the summer months in Richmond, VA, your feet may swell because of the hot weather, and larger shoes would help this. These provided some relief for about a week, but then the problem was back, just as bad as ever.
Throughout this entire time, I had been taking over the counter painkillers such as Advil to try to help the pain. I thought Advil being an anti-inflammatory would help, but it was of no help at all. The painkillers literally had no effect on the pain, either on or off the bike. I could take 6 Advil and it was zero effect.
Enter the Orthopedist
At this point, I went to my physician. They X-rayed my foot to make sure it wasn’t broken. It wasn’t, it just felt like it. My physician referred me to an orthopedist in the Richmond area. The orthopedist examined my foot and said my issue was purely a mechanical one, that I needed a pad placed directly behind the ball of my foot to spread the toes out and increase blood flow, and that would solve the numbness issue. He gave me two pads in from Hapad to put in my cycling shoes and instructed me in how to placed them. He suggested first taping the pads in place and attempting some rides with them before peeling off the backing and attaching them to the insoles with the permanent adhesive.
I was relieved this was just a mechanical issue and it could be fixed with inserts. I placed the metatarsal pads as instructed by the Orthopedists and went on a couple rides. They did help the hotfoot problem, but they were very uncomfortable. They meta tarsal pads he gave me fit under the arch of the foot, a very tender and soft area. They were also large, probably about 3/8” high. So while they spread the toes out, I had a feeling of something pressing into the arch of my foot, which was painful as well. Now when I got off the bike, instead of a numbness, I had this achy feeling all through my foot from this foreign object pressing into my foot in all the wrong places.
The Orthopedists had also told me about a company called e-Soles. They use a computer to scan the bottom of your foot and make an insole custom for you. He said people looking for a more permanent solution often had better luck with the e-Soles than the metatarsal pads. The cost for the e-Soles was $200, but at this point, I just wanted some relief. So I called up the local Richmond rep and scheduled an appointment. They scanned my feet, though they had a lot of problems with my right foot, which was the foot that really was bothering me. After about two weeks, I received the e-Soles in the mail. They did have a metatarsal pad on them to help spread out the toes. However, since it was integrated into the insole there wasn’t anything to push up into my foot. So that was an improvement.
The e-Soles were comfortable to ride in, but they really only helped the hotfoot problem a little bit. They did completely solve the problems I was having in my left foot. But my right foot was still problematic. I think e-Soles are good insoles. I just think my right foot is screwed up so much, that I needed something more.
But It Continues...
At this point, I didn’t really address the hotfoot issue much more. I just sucked it up and kept riding. Amazingly, with all these problems, I rode 7150 miles in 2006 and 6033 miles in 2007. All of them hurting. One thing I could tell l is that I could vary my position on the e-Soles insert, and sometimes the pain would be less. But this was often not repeatable. Part of the frustrating thing during 2006 and 2007 was that sometimes the problem would be a little better, and I would think I hit on something, then only to get worse again. I should have went back to the orthopedist, but didn’t. I just kept riding through the pain, I guess deciding this was the way it would be.
In the spring of 2008 I tried to fix the problem was purchasing a pair of Shimano cycling shoes with carbon soles. These would be very stiff, and the hope was this would better distribute the pressure over my entire foot, not just in one spot. Initially, these seemed to help a little. But as always, then the problem came back in my right foot, as bad as ever.
I moved to Appleton in June 2008, and in the winter of 2008, I started riding the CompuTrainer at the Recyclist. Recyclist is a Specialized dealer with their Body Geometry line of shoes and clothing. At one point in February, we tried a pair of Specialized shoes with the various different Body Geometry insoles to see if that helped the problem. What was nice is we could put in new insoles and I could ride the CompuTrainer for an hour. If it felt worse, I could make a change right away. I liked the Specialized shoes. They had a nice roomy toe box that felt very comfortable, so I bought a pair of those. The insoles with the largest metatarsal pad seemed to work a little better, but there was still no real relief.
So after almost three years, 4 different pairs of shoes, several different insoles, multiple adjustments of cleats and a trip to an orthopedist, I was still nowhere. In fact, in early March of 2009, my problem was worse than ever. My right foot burned in pain every day. I literally would only where shoes to go from the indoors to the car. I had to do something. This is when I found Northeast Wisconsin Foot and Ankle Associates and Dr. Tim Tougas, a Podiatrist here in Appleton and a road cyclists. So I made an appointment. My experiences with Dr. Tougas will be the subject of my next post, and what is hopefully the solution to this problem.
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