mikepwagner

When I go on a longish ride (for me) - 4 or 5 hours, I get an excruciating pain in the middle and "ring" toes on my left foot. The pain usually starts after an hour or so, but doesn't get excruciating for another 3 or 4 hours.

I doubt it's the shoes and/or fit. I get the same pain on my 1985 Tequesta with sneakers/cages and my 2012 Motobecane Immortal Force with Ultegra clipless pedals and Shimano R087 shoes.

I am trying to figure out if I am clenching my toes as I pedal or something like that.

Any ideas?

RT

Sounds like a symptom of Morton's Neuroma. There are many articles on this board about it, and Google also has some info. I didn't post as I don't know which article is best.

nesdog

When I ride over 4 hours or so, I'll get something like this in my right foot, large toe. Been trying to figure it out for a while and then I came up with this answer; I'm using Speedplay Frogs on my road bike. They have tons of float. But what I realized was that my natural pedal stroke has my right foot rotating outwards a touch. That means that I get to the end of the float, and the shoe stops rotating, putting pressure on the opposite side of the shoe, right where my big toe is.

I just did a century. I made sure to be aware of the way I pedal and not let my foot move so far over. By the end of the day, I had much less toe pain than normal for that long of a ride.

Bob Dopolina 

Dude, you just learned me something!

I'm in the same boat as the OP and after reading a few articles I'm going to take it up with my Doc, next visit. In the mean time I think I'll give a 'dome' a try.

OP, check the link above.

fstshrk

Bob, there are many treatment strategies for Morton's neuroma. Some Dr-s are very quick to jump to surgical treatment which has a 1 in 10 chance of actually making things worse without any way to reverse the situation.

FYI

Bob Dopolina 

Thanks for the heads up. I always start with non-invasive solutions to start. Getting cut is always a last resort.

First step is ejimication on my part and diagnosis from my doc.

RT

But Bobby, I thought you were under the immense burden of knowing it all!

Campag4life

Bob,
I have had it on both feet. I wrote a fairly long post about it quite a while back and I suggest you do a search with my user name for perspective.
It can be solved but it takes considerable effort. I suggest you exhaust every possible avenue before resorting to surgery or alcohol injections.
I ride pretty much pain free now but it was a long road to recovery. Like handlebar palsy aka ulner nerve damage at the base of the hand, Morton's neuroma is not uncommon among distance cyclists and even distance runners with high repetition of forefoot loading.

Some steps I suggest:
-Rigid sole carbon shoes with a 'lot of room in the toe box'
-Metatarsal button built into orthotic to build natural traverse arch...foot should be arched both north/south and east/west
-Move cleats back. Toe involvement with the pedal stroke promotes Morton's...relocating cleats rearward immobilizes forefoot. Ball of foot over pedal spindle can be a definite root cause or contributor. This worn out convention has caused more foot issues than anything else. Those with long toes generally will have cleats set too far forward promoting pressure right across the nerve that can become damaged.

Surgery aka tendon release is risky...not a great probability it will resolve it...same with alchohol injections killing the nerve that runs through 3rd and forth toes.

Good luck to all that have this insidious issue. It is mostly due to poor mechanics...shoes too tight squeezing nerves together with insufficient insole arch across foot...causing foot to collapse onto itself smashing nerves together causing damage. It can also be painful for just everyday walking.
Take inventory of all the shoes you own I suggest and and get rid off all narrow shoes and support your foot properly.

RT

Yes on all counts. I am not afflicted with MN, but I have also started a thread on foot issues. From plantar faciitis to nerve damage, my feet have been through through the gauntlet of pain. The three items mentioned by Campag contributed mightily to my (ongoing) recovery. I thought the best I was ever going to get was to stop the pain where it is, but have discovered that you can actually make it better.

Recently started riding with carbon soles, and what a difference.

Moved cleats back - even better.

Orthotics with the meta button - bonus. It took a few times, and you can't wear them every time you cycle or you get a new pain in your foot, but give the feet a chance to adjust to what is being done.

It is never too early to start supporting one's feet. As we get older, our body deteriorates. I posted in another thread that I make sure my kids' feet are supported well as in my cross country days, my feet were teh awsum. Not so much now, thanks to years and years of wearing Chuck Taylors (among other bad foot habits).

mikepwagner

I have done #1. Meeting with the orthopedist next week to look at #2. I will try #3 on tonight's ride. That won't be definitive, since I am only out for an hour on weeknights.

Last night, I tried toe socks (each toe gets a separate "finger" - and that seemed to help. The bunched cloth between the toes on the left foot seemed to help. Again, it was only an hour ride, so I am not sure. I think I am going to get some heavier weight toe sock before my (longish) ride on Memorial Day, and see if that helps.

RT

Something else I have recently tried and have rave reviews on, is Acupuncture. It is my first time, and it was a week and a half ago. My 'good foot days' are more in the past ten, but it will take several treatments.

Over the past two decades I have tried every remedy one can think of, and Eastern medicine is killing Western on the scoreboard. There is no one solution, but as you will all learn or have learned, it is an ongoing experiment. Acupuncture has not yet solved the problem, but the result of one trip is head and shoulders better than any remedy I have tested.

Campag4life

Sounds like we have similar paths. I basically started to ruin my feet with flat insole cycling shoes that were too narrow. I have a low volume foot and narrow ankle and tend to buy my shoes too tight when the front of my foot is close is std width. This in combination with a flat insole in the shoe caused my feet to implode on themselves. Unless you build a bridge 'laterally' not longitudnally which the foot must have as well for proper arch support, when pressure is applied like strong efforts cycling...the toes crash together and the foot becomes concave upward. The foot should be just the opposite...toes apart and concavity should be under the foot....this spreads the nerves apart. Nerve damage is hard to reverse as well. As long as it takes to develop it will take as long to reverse it. I also rode a full season in tennis shoes on platform pedals until I found the proper shoe solution. This helped strengthen the muscles in the foot and built a more natural arch due to more center foot pedaling. I rarely even think about this issue now. It used to be all I thought about.
A wise man once wrote, the definition of insanity is doing exactly the same thing over and over and expecting a different outcome. Injury is like that as well. For you guys out there that have foot pain....CHANGE your set up...or expect further injury. The longer the repetition of injury, the harder it is to reverse. Again, most of us cause our own problems which was my case as well and ironically most of us solve our problems through injury as well.

karungguni

Coming back to this and starting to make some changes. I have actually had Metatarsal arch problems all my life so likely a connection there.