The following blog post is not intended to constitute medical advice. It is simply a recounting of what I have went through with my hotfoot problem, what I tried to do to fix it and my experience working with a podiatrist. If anything, I would tell you to see a qualified medical professional sooner, not later if you have hotfoot or any other sports related ailment.
In March of 2009, I resolved to find a way, any way to get my hotfoot problem resolved. First of all, I had resolved to do Ride Across Indiana in July 2009, and I didn’t want to deal with a painful foot for a 160 mile ride. But more immediately, while for the last 3 years I had been able to put up with the pain and ride through it, my foot was now worse than ever. It hurt on days I rode or days that I didn’t. Every long ride was a new experience in suffering. It was clear, find a solution to the problem or stop biking. Completely.
In my last post, I talked about my experience with an Orthopedist in Richmond, VA. In the end, this wasn’t very fruitful. I still had the same problem, maybe a little better, but really the same problem. I think one of the things I did wrong was that I only went once. When the problem didn’t get better, I should have went back for another appointment and further examination. But one thing I have learned since is that I don’t think my examination and diagnosis 3 years ago in Richmond was very thorough. And that probably contributed to not getting the problem resolved then.
I needed a foot specialist, so I started looking for a podiatrist that specialized in sports medicine. Someone who specialized in cycling would be even better. I needed someone who wasn’t going just to examine me for 3 minutes, but someone who really understood what I was going through and could work with me to find a solution. Upon researching different podiatrists in the Appleton area, I found Dr. Tim Tougas at Northeast Appleton Foot and Ankle. Dr. Tougas is a board certified podiatrist with experience in sports related injuries. And he is a road cyclist. Jackpot.
I made an appointment and gave the receptionist the details of my condition. I also told her that was a cyclist that liked to ride 150-200 miles a week, and that was probably the primary cause. My appointment was on a Monday, and before I headed over, I put all the different cycling shoes in a bag with all the different insoles so I could explain everything that had happened. This time I was serious. I didn’t want a five minute examination, I wanted to get to the bottom of this.
I met Dr. Tougas and explained the whole history of the problem. I showed him all the shoes and all the things that had been tried. He put me into a chair and examined my feet, especially my right foot. He was able to put pressure right on the spots that were causing the pain. Dr. Tougas explained the problem I had was that the nerves between my big toe and second toe and the nerves between my third and fourth toe were inflamed, and this was causing the pain (he did not use the word Neuroma, but I think that is the medical term). The root cause of this was that the nerves were rubbing up against the bone, irritating the nerves, causing the inflammation and then the subsequent pain. He did an excellent job explaining all of this with the use of a diagram of the foot in the exam room.
The fix was simple. I needed a pad in my shoe to get that bone away from the nerve it was irritating. You often hear about the need to spread out the toes, as this will increase the blood flow and help hot foot issues. My issue was to get that bone away from the nerve it was irritating. Dr. Tougas marked the area on my foot with the worst pain with a magic marker, and transferred this location to one of my insoles. He then placed a foam pad on the insole and cut it to the appropriate size. He said this would result in immediate relief of a lot of the problem, because I wouldn’t be further irritating the nerve. He also said though, that once irritated, the nerves tend to take a long time to calm down, so it would be a couple-three months before I was fully recovered.
Overall, I was very impressed. Dr. Tougas spent probably 30 minutes with me. E asked about the type of riding I did and we talked about cycling. He quickly identified the problem and explained to me exactly what was going on and how we were going to fix it. He said we had the option of a cortisone shot as a short term fix, but it was really more important to treat the cause. I appreciated all of his information because I felt like I could be a partner in my treatment and recovery. And knowing what we were doing and why we were doing it, I could give him better information at my next appointment for how my foot was progressing.
Still though, I was a little skeptical. I don’t think that had anything to do with Dr. Tougas, but more with the fact that I had been going through this problem for three years. Could it be as simple as a foam pad placed in the right spot? I had had a few times where I would have some improvement only to regress again. So I really didn’t know what to expect. But that Monday I had my bike and I was determined to try it out. So even though it was only about 40 degrees, I went and did a 23 mile ride.
I was shocked. For the first time in 3 years, there was no pain. There was some discomfort because the foam pad felt a little high in my shoe (but he had told me this would probably be this way for a couple rides) but overall, for the first time in a long time, my foot felt normal. I rode a few more times that week, including a 90 mile ride around Lake Winnebago. Amazingly, I would say about 80% of my problem was solved. On the 90 mile ride, I had some numbness around mile 72, but this was a long way into the ride, and plus, Dr. Tougas said all this wasn’t going to go away overnight. But the improvement was remarkable.
The only downside of the foam pad is that it was not durable enough. Over three week and almost 600 miles, I wore the pad down to where it was providing less and less relief. I was still better than before, but I would say at the end of the three weeks, we were probably at a 60% solution. But overall, this was a very important step. We now knew we were working on the right problem. And we knew the solution. Get a pad in the right place to keep the nerve from getting irritated. Now it was just a matter of getting the pad to be durable enough so it wouldn’t wear out every three weeks.
I am planning at least one more blog post to cover what we have done from this point forward. But at this time, I want to stress, if you have a hotfoot problem, make an appointment with a podiatrist who specializes in sports medicine. Don’t let the problem go on and on like I did. In my case, I started getting relief the same day. Your case may be different, but a podiatrist is trained to understand how the foot works, and rather than you fiddling with shoes and cleats to fix the problem, they can tell you exactly what is going on, what is causing it and design a plan to address it. One of my major regrets is that I could have had my problem fixed 2 years ago if I would have been more proactive in going to a podiatrist.
When you go to your podiatrist, bring your cycling shoes. Be prepared to discuss how much riding you do and what type. This can help them to understand the cause of the problem. Ask lots of questions. Understand what is the cause of the problem and how they are planning to treat it. This may involve a pad in the shoe or custom insoles or orthotics. But you are the only one who knows how your feet feel. Knowing what you are trying can help you give the best feedback to your doctor so they can get you feeling better in the shortest time possible.
In part 3, I’ll talk about a more durable metatarsal pad and the decision to purchase orthotics.
Showing posts with label hotfoot. Show all posts
Showing posts with label hotfoot. Show all posts
Thursday, May 14, 2009
Wednesday, May 13, 2009
Issues with Hotfoot
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.
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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