Foot problems in cycling can occur from riding in poorly fitting shoes or as a result of ramping up training intensity too quickly. The most common problem is pain or pressure in the ball of the foot (Metatarsalgia) – sometimes also accompanied by swelling.
It is usually caused by compression of nerves and blood vessels in the feet and may be exacerbated by poor shoe fit, high arches, cleat positioning and tight calf muscles. Treatments are aimed at removing pressure from the metatarsal area or redistributing it to relieve this pressure.
Plantar Fasciitis
Plantar fasciitis is the most common cause of heel pain. It is a condition that results from repetitive microtrauma to the plantar fascia. Often this occurs in athletes and those who spend most of their time on their feet, such as factory workers or teachers. Plantar fasciitis can become chronic and interfere with regular daily activities. The pain of plantar fasciitis typically starts in the morning or after a long period of sitting or standing, and is more severe when exercising or walking on hard surfaces. The pain usually decreases as the day goes on, but returns at the end of the day.
Treatment of plantar fasciitis includes avoiding repeated foot trauma, weight loss and stretching exercises. Injection therapy may help reduce pain, but must be used sparingly to avoid weakening of the fascia. It can be used in combination with other treatments such as orthotics and a physical therapy program.
If conservative methods of treatment are unsuccessful, electrodiagnostic studies might be performed to evaluate S1 radiculopathy, tarsal tunnel syndrome and medial calcaneal neuropathy (Baxter’s nerve entrapment). An interprofessional team is critical in managing this painful condition; nurses, pharmacists, physical therapists and rehabilitation specialists can all play a role in patient education and pain management.
Achilles Tendinitis
Achilles tendinopathy is characterized by pain and stiffness in the back of the leg and heel, usually after exercise or walking. The condition may be more serious if it involves a complete tear of the Achilles tendon. The pain is caused by irritation of the tendons and a buildup of scar tissue. The condition can occur in people who exercise or participate in sports that require repetitive running, jumping, and lifting weights. It can also be caused by wearing flat shoes that put too much stress on the tendons. It is a common injury among runners, football players, and other athletes.
The condition can be treated with self-help treatments, such as ice, compression, and elevation. You can also try wearing shoes that are more supportive and putting a heel lift in your shoe. You can also do calf stretches to increase the strength and flexibility of your calf muscles.
If you have severe Achilles tendinopathy, you may need to see a doctor who specializes in sports medicine or physical and rehabilitation therapy, known as a physiatrist. They will examine your legs and ask you about your activity level and the type of shoes you wear. They may also recommend imaging tests, such as X-rays and MRI. These tests can show if the Achilles tendon is swollen and inflamed or if it has partially ruptured.
Metatarsalgia
A dull or throbbing pain at the ball of the foot (metatarsalgia) can make it difficult to walk or participate in other activities. The pain may be sharp and severe, especially when walking up or down stairs or hills or in hard shoes. The pain may feel like a stone or pebble is in the shoe, be hot or cold to the touch, and appear red and swollen.
Metatarsalgia can be caused by a range of problems or conditions, including:
The ramified network of fasciae that envelops muscles, tendons and bones plays a vital role in movement and power transmission. When this network tightens or shortens, it restricts the normal rolling behaviour of the foot at heel strike and causes abnormal pressure to be concentrated on the forefoot, particularly the metatarsal heads.
Poor foot posture such as flat feet, splayfoot or bunions also contribute to increased pressure on the forefoot. A bunion is a deformity of the base joint of the big toe, which causes it to angle towards the second toe. This causes extra stress on the metatarsal heads which can cause pain.
Exercises that strengthen the foot muscles and arch help to reduce the overloading of the forefoot, as does regular use of pads or arch supports in shoes. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can reduce the discomfort.
Neuroma
A neuroma, also known as Morton’s Neuroma or Interdigital Nerve Entrapment, is a painful foot condition that results from compression and irritation of the digital plantar nerve in the ball of your foot. This causes pain and numbness in your toes. This condition usually develops gradually. It is most common in individuals who wear shoes that are too narrow in the toe box or those who play sports that put repeated pressure on the ball of the foot, such as running or racquet sports. The constant squeezing of the toes and nerves in these types of shoes eventually leads to inflammation that builds up over time.
When conservative treatments fail, a podiatrist can use padding techniques to relieve the pressure and reduce the swelling of the nerve. He or she can also prescribe orthotic devices that separate the toes or change where the pressure is placed in the shoe, decreasing the overall pressure on the affected area. Other treatment options include ice therapy, anti-inflammatory medications and corticosteroid injections.
When nonsurgical treatments are not effective, a foot and ankle surgeon can recommend surgery to remove the thickened tissue that has developed around the nerve. This procedure, called a neurectomy, has a high success rate and relieves pain. However, permanent numbness is sometimes a side effect of the surgery.