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Digital neuralgia while cycling

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Smith, Jul 29, 2008.

  1. David Smith

    David Smith Well-Known Member

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    Hi all

    Recently (last 6 months) I have been using the bike to improve my fitness.
    I usually do between 2 and 4 hours (20 - 45miles) over hilly terrain on and off road. I tend to pedal with just the ball of my foot on the pedal. However since last week, after about 1 hour riding I get a really excruciating burning, stabbing pain in, what feels like the 4th 5th digits. Getting off the bike and standing immediately relieves the pain and if I walk around for 30 seconds or so I can cycle for another hour.
    I am assuming there is irritation of the digital nerve in the 3rd interspace since squeezing it reproduces the pain but more in the 4th toe.
    What kind of modification can I make either in shoe or to the pedal to relieve this.
    It does not hurt at all when walking but then I do not walk for hours at a time since I have a spinal stenosis that prevents me doing this.

    Cheers Dave
  2. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi Dave I recently had a cyclist in who said this was a very common sympton among cyclists. This particular client had an extremely hard insole inside his cleats which we have exchanged for a softer one and have tried adding cushioning and a met dome. No feed back yet.
    Good Luck with yours a look forward to hearing some expert opinions
  3. What kind of pedals are you using i.e., cleats? And what kind of shoes- A wider/ looser shoe should help BTW. Also take a look at the crank arms- any excess scuffing from medial malleolus?

    Any more details from an objective work-up you can offer that may help? Best thing to do is find a friend with a turbo trainer and video yourself cycling.
  4. David Wedemeyer

    David Wedemeyer Well-Known Member


    I too am a road cyclist. I have been through quite a few different bikes, cleats, shoes and finally bought a new pair of shoes and designed a nifty pair of orthoses for myself.

    The easy solution is as Simon said, a wider shoe possibly. Certain brands are notoriously narrow (ok they all are), Shimano, Vittoria, Nike.

    Sidi, Lake and Pearl Izumi tend to have a wider toebox which may help. In my case my entire toes went numb prior to changing shoes and adding the inserts. I finally spent the money and bought a pair of Sidi Genius 5.5 and I wasn't disappointed. I also changed pedals to Shimano SPD-SL (Look has a similar wide base).

    I also found that what was true for my subtle cavus, wide Barney Rubble foot held true in a cycling shoe. I have a high flexible arch and valgus forefoot so I used felxible composite sheets, full length, added 1/16 poron and posted the entire foot heel to forefoot in 4 degrees valgus by adding plaster to the casts :cool:. No more numbness.

    The full-length valgus posting really helped. I noticed that I tended to ride with my knees/hips canted in varus, apparently that coupled with the narrow shoes really made my feet supinate on the pedals.

    Bike fit is important as well as you know. Tell us more about your feet, bike, crank, shoes etc?
  5. David Smith

    David Smith Well-Known Member

    David and Simon

    As you understand I can't give much info on riding biomechanics since I can't watch myself. However I am just about to purchase some 2D video analysis equipment so perhaps I will be able to do this soon.

    I have always worn wide fitting deep toe box shoes since I tend to have deep met heads and retracted 2nd. The right foot that is giving pain is slightly valgus in the forefoot and previuos 3D video and force plate analysis shows that I do supinate after heel strike and then go into pronation with a STJ ROM of around 8-10dgs and max pronation of STJ about 6-7dgs.

    I made myself orthoses (OTC modified)several years ago which were very succesful in relieving bunion pain and hip pain plus resolving a 5th mpj plantar h.d. I wear them all the time and replace them as required.
    I'm not sure how orthoses are applicable to cycling since there is only a reaction force acting on the met heads.

    I'll try a valgus post in the forefoot and check that my shoes are wide enough and see what happens.
    Actually, today I did look at the sole of my shoes that I usually use for cycling and there is a wear hole right under the 3rd 4th met area. So perhaps a new pair with a more rigid sole might be better to spread the local forces.

    It is strange how its quite difficult to be objective on yourself without some feedback.

    Cheers Dave
  6. David Smith

    David Smith Well-Known Member


    I've been looking at cleats and they might be good since the contact area is different to the flat symmetrical pedals I have at present.
  7. This is what I was trying to ascertain earlier, i.e. were you wearing cycling shoes or trainers and were you using cleated pedals or not. I guess you've kind of answered that in a round about way.

    Your question re: orthoses and GRF in cycling raises an interesting point: if I use a three quarter length device in a cycling shoe with a cleat plate beneath met heads 2/3 will the orthoses have influence on foot mechanics?

    The answer is yes.

    Also you can add a wedge between the cleat plate and shoe if necessary or use fairly rigid full length shells. Also, some shoes have a built in varus wedge.
  8. Craig Payne

    Craig Payne Moderator

    I get the same thing when on a step machine in the gym - I only get it when using BM's low gear axis; I do not get it when I use BM's high gear. I know there are issues with BM theoretical construct, but when I use the concept to change my forefoot weightbearing, it helps .... now there has to be a research project in that!
  9. David Smith

    David Smith Well-Known Member


    You wrote
    I can see how this is possible with cleated shoes since there torque can be transmitted thru the shoe sole and so apply forces at the heel that have origin at the forefoot.

    You answer your question with an emphatic yes, how do you arrive at this firm conclusion.


    Yes if I can get the foot pushing off on the 1st 2nd met heads more than the 3rd 4th then this should stop the pain. I can actually reproduce the pain by standing in tip toe on the right foot only. Naturally I bear weight on the 3rd 4th met heads, by conciously everting the rearfoot the pressure is borne by the 1st 2nd heads and the pain is relieved.

    Cheers Dave
  10. Emphatic? Just answering the rhetoric question. I was referring to cycling shoes and like you, I believe that the torque is "transmitted" through the shoe and also through the foot. Do you think that there will be no "transmission" in softer soled shoes? What effect does a 4mm polyprop shell have on the stiffness of the shoe? I also think the shoe upper is important BTW.

    Dave, you can probably draw this one out. As the foot pushes against the pedal we have a dorsiflexion moment from the forefoot against the pedal and a plantarflexion moment from the achilles at the ankle joint to counter this and prevent the foot dorsiflexing on the leg as the power goes on, at the midfoot these forces will create what Kevin terms "an arch flattening" moment. Do you think 3/4 length orthosis will have any influence in countering this arch flattening moment in this situation?

    Of interest, I had a pretty good triathlete in for review today. I'd previously made him two pair of devices, one pair for his racing flats and a pair for his cycling shoes (cleated). He loved the ones in his running shoes but was getting arch irritation in his cycling shoes- he put this down to too much compression between the shoe, foot and orthoses.
    Last edited: Jul 30, 2008
  11. David Smith

    David Smith Well-Known Member


    My first thought is no not unless the shoe is very tightly bound to the foot and th efoot cannot slide inside the shoe.

    I will have to look at this more closely

    Cheers Dave

  12. So you don't think there will be any interface pressure between the foot and an orthosis in a shoe that isn't very tightly bound? BTW have you ever worn cycling shoes? They tend to be very tightly bound and have a rigid shank. Why do they need a rigid shank? & to reiterate a previous question, what effect will the orthoses have on the shank stiffness?
  13. Craig Payne

    Craig Payne Moderator

    The way I look at this sort of thing is to: put your finger into a bench mounted vice grips; screw it up tight (but not too tight); ... note how much the bones of the finger can actually move inside the skin.

    BTW, this reminds me of a very old definition I use of gout with the students. It goes something like: Tighten the the vice grips as tight as possible, that is rheumatiosm; give it one more turn, then that is gout.
  14. Did this with an index finger gripped about the intermediate phalanx and rotated. What I did note is a large percentage decrease in motion at the intermediate and distal phalanx compared to ungripped state, while the proximal phalanx continued to rotate as before = increase rotation at the intersegmental joint= change in kinematics.
  15. David Smith

    David Smith Well-Known Member


    you wrote
    Clearly there will be some change in foot arch stiffnes but whethe ir would be significant in terms of reduction in internal tissue stress is not clear, to me at least.
    I have not worn cycling shoes but I would imaginge they would need to fix around the heel to have a significant effect on arch stiffness in the saggital plane.
    I feel it is more likely that there is a resistance to torque in the frontal plane since both rearfoot and forefoot have levers available to them. To cause a bending moment you require three forces anf the shoe and orthosis only has two in the saggital plane.
    In the frontal plane the twist of the forefoot on rearfoot would allow levers that could be lengthened and the relative thickness, second moment of area, increased by the orthosis.
    The bespoke shape of the orthosis may reduce the tendency for seperate rotation of orthosis in relation to foot. So does this mean that if a shoe is tightly fitted that a 3/4 length orthosis can significantly change the mechanical properties of the foot after heel of during normal gait. Or is this characteristic limited to the cleated shoe that can apply pedal reaction forces in two vertical directions, which is impossible with normal ambulation.

    So to answer you question Simon, cleated shoes require a stiff shank to enable them to resist frontal plane torque that is able to be produced / significantly increased, due to the unique force transmission properties of the cleated shoe. IE the cleat allows a vertical push pull twisting action that is difficult / impossible to achieve without a shoe fixed to the pedal, or the ground in the case of normal walking.

    Cheers Dave
  16. Dave,

    This is what the American Academy of Podiatric Sports Medicine have to say:

    "Besides selecting a bicycle that meets your specific needs, proper shoes are the most important piece of cycling equipment. Cycling shoes must have a stable shank to efficiently transfer power from your feet to the pedals. The lack of shank support in sneakers allows the foot to collapse through the arch while pedaling, which may cause arch pain, tendon problems, or burning under the bottom of the foot. A rigid shank protects your feet from the stress of pedaling."

    Doesn't your third force needed to create the bending come from the body above transmitted through the shank to the talus?

    P.S. Cycling shoes had a stiff shank before cleated pedals were invented and cleated shoes release from the pedal when you twist.

    Do you think the interface pressure between the foot and the 3/4 orthosis would equal zero in a training shoe when cycling?
    Last edited: Jul 31, 2008
  17. Griff

    Griff Moderator


    I'm sure its been discussed on here before and I've missed it - could you point me in the direction of the paper/discussions which take issue with BM theory please

    Many Thanks
  18. David Smith

    David Smith Well-Known Member


    you wrote

    I was thinking of rearfoot to forefoot deformation relationship. IE about the mid tarsal joint. If however the model is looked at as deformation about the 1st cuneiform-navicular joint then there could be a splinting effect of the foot -shoe -orthosis laminate. I think however in regard to the mid tarsal joint the frontal plane twisting torque may be more relevant in reducing arch flattening ie supination of the fore foot on the rearfoot.


    The three forces required to bend the foot (diagram1) are the pedal reaction force, body weight force and achilles tendon force. There is no equivalent achilles tendon force on the shoe and orthosis. There are three forces present about the Nav-cuneiform joint however (diag 2) - bodyweight, shoe sole and lace forces.
    Diagram 3 indicates that the cleat and padal forces react agaist the heel shoe counter forces causing a torque in the shank. This torque will be much higher with less displacement if the shoe shank is reinforced and has an orthotic shell in it.
    Without the cleat (diag 4) the foot can only rotate about the forefoot contact point on th epedal eg the 1st mpj.


    PS right click on the image to print or save for easier viewing

    Cheers Dave
  19. David Smith

    David Smith Well-Known Member


    Yes - there is no significant interface pressure. Right now I have orthoses in my shoe and staning on the ball of my foot I can twist my foot around and feel the orthosis sliding quite freely about my plantar foot. There is also a small gap (several mm) between orthosis and foot heel.

  20. David Smith

    David Smith Well-Known Member

    Simon David craig Hj

    At the weekend I used a pair of Cat walking shoes with a stiff, thick sole and probably a bit more roomy than the original shoes in the toe box. Outcome was no pain. :cool:

    Cheers Dave
  21. Dave:

    Interdigital neuritis/neuroma is one of the most common foot complaints in cyclists. This is generally due to shoes which are too tight causing increased pressure on the interdigital nerve due to excessive medial to lateral compressive forces from the shoe upper. The best solution is to get the widest shoe that will fit your foot and/or size up a half shoe size to increase shoe width. Also it may be helpful to take out your orthosis and just add a metatarsal pad inside the shoe and replace the insole with a thinner insole to give the shoe more volume. Evaluate shoe fit always with the socks that you will be riding in and with the foot weightbearing. You should be able to "pinch" some shoe upper dorsally over the metatarsal heads if the upper isn't too tight on the foot. It is amazing how quickly the pain resolves once the tight shoe source of mechanical compression to the interdigital nerve is removed. This is the same basic philosophy I use in treating interdigital neuromas in women (or men) wearing slip on shoes.....get them out of the tight shoes!!
  22. Adam

    Adam Welcome New Poster

    Had similar digital neuralgia which was relieved by changing the bike seat (but no change in set-up). Impingement at ischial tuberosity??
  23. David Wedemeyer

    David Wedemeyer Well-Known Member

    Adam I believe that it is actually the pudendal nerve and /or artery that is affected by the seat in cycling. I know a number of cyclists that have had this problem and it is not a pleasant feeling from what I am told. You can actually damage your reproductive capability if you ignore this symptom:morning:.
  24. Other modifications one can consider for interdigital neuritis/neuroma while cycling is to:

    1) move the cleat on the sole of the cycling shoe as posterior as possible in order to shift the pedal reaction forces more posteriorly on the foot;

    2) cut a 1/8" (3 mm) thick adhesive felt pad that ends distally at the metatarsal necks and proximally at the midtarsal joint level and adhere it to the cycling shoe insole;

    3) increase the cadence of cycling so that a lower gear may be used and less force is thus required at the pedal/shoe interface. Generally, 90 revolutions per minute is considered to be a relatively good cadence to cycle at (this cadence will, of course, change depending on individual riding styles); and

    4) make a custom foot orthosis that has increased thickness at the anterior edge and ends slightly more distal than normal to transfer plantar reaction forces from the metatarsal heads and toward the distal metatarsal shafts.

    Hope this helps.
  25. David Smith

    David Smith Well-Known Member

    Thanks for your advice Kevin

    All the best Dave
  26. Foot Traffic

    Foot Traffic Member

    Late posting I know, but my experiences with this are that lateral forefoot posting does work very well, however if the shoe is too narrow initially at the level of the met heads then any additional padding will be no better (possibly worse).

    A lot of clients don't like admitting it, but often they are sold the flashest shoe by an over zealous shop staff member who just sees the cool features but not the suitability to the wearer ($500+ mistakes). I have sent a number of people back to change to a more appropriate shoe

    Good cycle shoes for wide feet - Northwave (especially those with mesh adjacent to the met heads), the Northwave tribal is a triathlon shoe and definitely the widest I could find. Other brands include Shimano and Lake.

    Bad cycle shoes for wide feet - Specialized, Nike, Sidi, Gaerne

    I hope this helps
  27. Heather J Bassett

    Heather J Bassett Well-Known Member

    Foot traffic Hi, you can never be too late with new information.:good:
    Many of us trawl through threads as we come across things that we have not dealt with before, does not matter when the info arrived on arena we can still use it so a big thanks for thi s:D
    What part of NZ are you in?
    I am visitiong later this year and hoping to meet and greet some pods while I am there if I can find any takers
  28. Foot Traffic

    Foot Traffic Member

    That would be great for you to visit here.
    We are based in Glendowie - Auckland.
    I'm sure there will be other Kiwi Pods keen to make you aquaintance.
    Keep in touch
  29. David Smith

    David Smith Well-Known Member


    Thanks for the additional input that backs up what others have said, -- but

    For shoes! I didn't pay that much for my bike.

  30. Foot Traffic

    Foot Traffic Member

    This is an expensive sport mate. My bike is close on $NZ11000 (sponsored rider thankfully), and that is certainly not the most expensive around.

    As for the shoes - a pair of sparkely new Sidi Genius Carbons bedecked in World Champion colours will cost well over $500.

    I have worked closely in the past with a Bike shoe importer here in NZ who stocked a shoe with a mouldable carbon sole which was $NZ900. Strange thing was they had to be cooked in the oven to an optimal temperature and then moulded around the cyclists foot to provide the "necessary support"!! Thing is, even as a Sports Podiatrist I had trouble manipulating the sole once heated and I couldn't even be sure if I was achieving what I wanted to. Not sure how the shop staff can be confident selling them but a few were sold - that scenario sets up an interesting argument about who should be in control of dispensing such equipment!

    I certainly was in 2 minds about putting someones $900 shoes in an oven.

    Needless to say the shoes aren't being sold here anymore.
  31. David Smith

    David Smith Well-Known Member


    Ah! New Zealand Dollars, so at the current exchange rate NZ$500 = about a gallon of petrol here (UK) then with enough left for a bag of chips (like fries, only way better) on the way home :D

    Much respect Dave:drinks
  32. David Wedemeyer

    David Wedemeyer Well-Known Member

    Foot Traffic

    Your shoe recommendations are very useful, thank you. I had never seen either the Northwave or the Lake shoes locally, but I intend to check them out.

    I always found that although I have a wide foot that SIDI fit me very well. I had a horrible time with Shimano oddly. Now that I think about it on occasion no matter what shoe I wear my feet can become numb on a long ride. At least they don't produce the horrible arch pain I endured until I crafted a pair of nifty full-length inserts with a poron pad.

    Have you looked at the new Trek Madone. As a sponsored rider I am curious about your opinion of their design. I'm just an enthusiast but I am considering an upgrade and a more upright riding position.

  33. Foot Traffic

    Foot Traffic Member

    Hi there,
    Interesting about the experiences with different shoes - there must be a large variation between cyclists and there foot suitability to cycle shoes. It is hard to predict what would work best for each person.

    As for the Trek Madone (I am sponsored by an Avanti Bikes store here in Auckland so am riding their top end triathlon rig) they too are an amazing bike, and much improved on the previous model which suck to fairly standard geometry. The new ones are way stiffer through the bottom bracket and head tube so definitely suited to going fast. The head tube is a little taller than previous so it would provide a more upright position. I often ride with the Trek sales rep here and have often asked to take his Team model for a spin - I'll sneak out when he isnt looking one day.

    Make sure you get it with Sram compnentry though as this will compliment the bike nicely.

    David, if I attached these pics correctly, the 1st is of the latest Team Astana Trek Madone and the other is my own Triathlon bike, Avanti Team Chrono. This expo was at the famous Roth Ironman in Germany we raced at in July this year. Any bike enthusiasts would waste many hours in this expo. They also had some great running shoe displays.


    Attached Files:

  34. David Wedemeyer

    David Wedemeyer Well-Known Member


    Greetings from the West Coast of the US.

    Dang sexy rigs. I am completely jealous.

    A $5,800 US bike is over the top for me but when I saw the new Madone 6.9 it was a little like falling in love for the first time! The bottom bracket is an absolute monster and the integrated seat mast and tapered steerer tube are design genius. It is light and stiff as you know.

    I am curious why you prefer the SRAM components over Shimano and Campy. I have only seen the Madone with Shimano componentry around here:bang: and am hearing more and more about this groupo.

    I recall the days when chromoly was the material du jour for frames and you had to sneak your hands down to shift the bike, spokes were spokes and symmetric and bars had one flavor. What an explosion in choices and materials.

    As for cycling shoes I believe that you are correct and that you really have to find a shop with a good fitting stock to select the best one for your foot and needs. It is no different for regular shoes, we all know that feet are so highly individual

  35. Foot Traffic

    Foot Traffic Member


    The Sram seems to be a good group, and its new so always cool to have flash bits on the bike. All the pro teams in the tour that are using them seem to rate them highly.

    I remember those days of having to sit down to change gear, and I'm glad we dont have to worry about it now!! Cycling is the greatest sport isn't it.

    Watch the pursuit final in the Olympics today, the bikes the NZ team are riding is the track version of my frame you see in that pic.

    I haven't ridden in the states yet (apart from Kona), and am coming to the PFOLA conference in Vancouver later this year so I may bring the bike and have a week checking out your part of the world for it's cycling.

    All the best,

    Rob Dallimore.
  36. Gibby

    Gibby Active Member

    Dear Dave-
    I have a nurse who is a cyclist with the same issue.
    Try a thick, felt pad, applied just proximal to the 4th metatarsal head. I applied one to her foot directly, it worked well, and we made her an orthotic with a similar contour. Instead of compressing together, the met heads will separate a bit through toe-off. Less pressure on the communicating branch= less pain.

    If not successful, simple exam, history, and some simple tests can confirm neuroma diagnosis. They respond extremely well to conservative treatments, injections, orthotics, etc.
  37. Diana Palin

    Diana Palin Welcome New Poster

    Hi all,
    I have a similar problem with a professional racing car driver. A predislocating 4th MTPJ with nerve irritation. Orthoses in place with met dome exactly located. Shoes stretched. Major problem though....... i cant change the shoes because they have to be fire retardent. Apparantly only the Italians can make and approve these shoes and we all know how us IT's pretend to have narrow feet and therefore make narrow lasts. After investigating and assessing the foot environment in situ further, we found that widening the pedal of the racing car helped disperse the forces over the MTPJ's and remarkably removed all pain during and post racing. Patient is now doing well!. Anyone thought to specialise in custom making footwear for these guys? (racing or bike riders)
  38. Malkor

    Malkor Member

    Increasing the distance between the plantar surface of the foot and the cleat interface decreases potential power output. Careful placement of a met dome to fill the void between transverse arch and the insole can help. i found no plaster fill between 1 and 5 (approx. 3mm) on custom orthotics worked well for off the shelf shoes.

    A few things to consider, as i'm a racer too and have similar issues!

    1/ Grab a pair of Bont A-One shoes, excellent heat-mouldable shoes ($459 AUD), once i moulded mine most of the issues were relieved (anecdotal i know!!)

    2/ LeMond wedges to deal with a forefoot supinatus or tibial varum. (remember both "issues" are purely subjective in reality, but can be used to balance a flexible foot, not necessarily correct a pathology)

    3/ Moving the cleat further back from the ball of the foot (1st MTPJ), you can potentially lose sprint power but is far more comfortable for tapping out the km's. Takes pressure off the plantar fascia and calf. I find with my cleats further back, i can still turn on the power in the last 200, but can ride 100+ kms without too much discomfort.

    4/ Pedals - I currently use Look Keo Carbon's but have found that i've bent them out of shape, thus i'm moving over to Shimano DuraAce, as they have a metal body and are stiff as hell. Look at it this way, track sprinters wouldn't use them if they sucked!

    5/ Crank length - in theory a shorter crank you can spin a higher cadence... think Armstrong in the 1996 tour the day after that Postal bloke died.

    Unfortunately, it seems to be trial and error, and thus potentially an expensive exercise.

    Good luck, take on board what u like, but remember no amount of podiatric experience can give u all the answers, it's a case of give it a go!
  39. David Wedemeyer

    David Wedemeyer Well-Known Member

    I'm following up on this thread to relate my experience with Bont cycling cleats. The footbeds are repetitively heat moldable at just 60C and have a wide toe box. I've found this the most comfortable road shoe yet (SIDI is my second choice) and I'm not currently wearing any foot orthoses (save for a poron layer I shaped in), which surprises the heck out of me.

    They're not cheap, I paid $400 US but worth every penny when you consider my feet went numb and were painful in the arches after about 34K when I hopped off the bike and took off my old cleats to walk.
  40. DALEK

    DALEK Welcome New Poster

    Hi Dave,
    This has happened to me (only once, i'm glad to say) and I put it down to the type of footwear, viz. flexible-soled and rather thin-soled old trainers. You don't say what you were wearing at the time of pain, but a stiff, sustantial trainer would be best; also make certain your seat height is correct: if it's too high, maybe excessive toe extension could induce neuralgia.

    Best of luck,


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