One of the questions bicyclists ask me most often is why their feet go numb when they ride. We talked about proper bike fit and cycling shoes in this post, and that’s a great place to start. Still, it is not uncommon for cyclists to complain of pain, numbness and/or tingling in the forefoot while in the saddle.
A common cause of such pain is Morton’s neuroma, an injury to the nerve between the toes, most often the third and fourth toes (counting from your big toe). The nerve becomes thickened or swollen, which can cause numbness, burning, tingling and other symptoms, ranging from annoying to quite painful. Some patients describe the feeling as if they are walking on something, like a bunched up sock or pebble, under the ball of their foot. Without treatment, the pain often increases over time. Because cycling puts pressure on the forefoot, the pain can progress to the point where you can no longer ride comfortably.
The exact causes of neuromas are unclear, but contributing factors can include flat feet, high arches, abnormal positioning of the toes, bunions, hammertoes and restrictive, tight shoes or high heels, which may be why neuromas are more common in women than men.
Morton’s neuroma is sometimes referred to as a tumor, but it is a benign issue and can be treated conservatively. Early diagnosis is important to keep the neuroma from getting worse. Treatment options for neuromas begin with decreasing pressure on the ball of the foot with metatarsal pads and/or arch supports. Choose footwear with a wider and deeper toe box in both your casual and cycling shoes to give the metatarsal bones more room. See a podiatrist for proper support positioning or custom cycling orthotics.
Cortisone injections, anti-inflammatory medications, icing and physical therapy modalities, such as iontophoresis and ultrasound, may also be needed for relief.
To continue your cycling, you may need to make equipment changes. Most new biking shoes have stiff soles, but make sure yours are stiff enough. Similarly, pedal systems distribute pressure differently; find the one that best for you. In general, move the cleat position closer to your heel and not closer to your toes. Experiment with the size of and position of your cleats and/or pedals.
Consult a podiatrist for proper diagnosis and treatment if you have foot pain that lasts for more than a few days.