Question: When I ride, I get severe pain in my left foot – it feels like somebody is shocking me. What is this, and what can I do about it? – Bob, Gaborone

Doctor Jeroen Swart: A sharp, shooting or electric sensations can be caused by compression of the interdigital nerves, between the bones of the forefoot (the metatarsals). This pain will shoot down the space between two toes, or feel like a hot spot under your foot. Repetitive compression or grinding of the nerve between the two metatarsals can result in scarring around the nerve (known as a neuroma) and persistent pain, even if you improve the fit of your shoe. A neuroma will be visible on an ultra-sound or an MRI, and can be relieved by injecting some corticosteroid – though surgical excision is the best permanent solution.

If there’s no neuroma, enough space in the front of your shoe could solve it. If your shoe has three velcro straps or multiple buckles, loosening the front two straps should do the trick. But many newer shoes use laces or ratchet dials with nylon wires, which make it difficult to reduce pressure in the front while maintaining enough retention for pedalling.

Another possible cause for your pain is ‘metatarsalgia’, from excessive flattening of the transverse arch of the foot: when pedalling, force applied to the pedals is transmitted through the forefoot. This can result in the transverse arch collapsing, exposing the interdigital nerves and either compressing them between the sole of the shoe and the metatarsals, or exposing the cartilage in the joint between the metatarsal and the first toe bone. You’ll usually feel this pain as a burning sensation under the front of your foot; it can be temporarily alleviated by scrunching up your toes.

Some cycling-shoe manufacturers (such as Specialized and Bontrager) incorporate a metatarsal button to lift the second, third and fourth metatarsals, supporting the transverse arch and reducing this effect. Or a podiatrist can create a metatarsal button on your existing innersoles for a reasonable price.
Lastly, the newer mechanical buckles of some shoes can create hard points over the top of the foot, and these can irritate the deep peroneal nerve as it becomes exposed over the top of the foot, causing pain and numbness. If you think this may be the culprit, try another pair of shoes, or add some padding to the tongue of the shoe.

A successful fitting

The most common cause of forefoot pain is excessive compression of the forefoot through wearing overly-tight shoes. This can result in insufficient blood flow to the forefoot, which then results in pain or numbness because of insufficient oxygenation of nerves and other tissues.
One way to assess whether a shoe will fit your forefoot is to trace around your foot on a piece of paper while standing and bearing weight on the foot. Take out the inner sole of your cycling shoe, and place it over this tracing. If the tracing is significantly wider than the innersole, your shoe will probably be too tight.

READ MORE ON: injury prevention tips