Member Case Study: Foot Pain with New Bike Shoes

author : AMSSM
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Question from Zev
I picked up my loved sport of riding in late April, after a four year layoff (busy with kids). In the 80's and 90's I logged probably a thousand miles a year or so. I wore crude Diadora shoe with plastic soles and laces for most of this time ! About 2001 I bought a pair of Carnac Altitudes that have carbon soles and no footbed. I rode without any problems.

Fast forward to 2006: 100 miles so far for June and 70 miles in May.

I started riding this spring with the Carnac shoes on Look pedals (with plenty of float). About five minutes into a ride I get sharp pain on the outer edge of my feet, just behind the pedal. The pain often radiates backwards, causing pain underneath my heels. I noticed this same pain while riding in toe clips on my mountain bike, and in a new set of Carnac M5 shoes that I bought on a whim to see if they would make a difference. The newer Carnac's are also carbon soled, but have a slim foam footbed.

When I keep riding, the pain usually subsides after twenty minutes or so, although sometimes it has hurt so much it made me want to get off the bike. Twice recently I've taken several Advil to mask the pain.

I've had one shop suggest I install SuperFeet footbeds in my shoes. I am looking for a better answer, and if necessary a referral to an appropriate specialist.

Answer from Marco Bosquez MD

Thanks for sharing the interesting problem with us. It sounds as if you experience this pain with the Carnac M5s, and in other shoes you use to ride on your mountain bike while using toe clips.

The location of the pain correlates well to a branch of the sural nerve. The sural nerve is located along the outer edge of the foot and has branches that supply the back of the leg and heel as well the lateral (outer) border of the foot, and 4th and 5th toes. The peroneal brevis tendon and the 5th metatarsal also sit along the area you describe.

It sounds as though the nerve is the culprit and it may be due to irritation by the Carnacs. You may be experiencing some compression of one of the nerve branches due to a tight toe box or tight fitting shoe along the mid portion of the foot with radiation of pain backwards along the course of the nerve. This would correspond well to the initial location of your pain just behind the pedal and also the course your pain travels. You might need to try a shoe such as the Sidi Mega which has a wider toe box. The SuperFeet footbeds might not be a bad idea if the current insoles have a high arch or a metatarsal pad as some do. These can also lead to local irritation.

I would also investigate other potential causes including the fit or setup of your bike. I would have a knowledgeable shop check everything from pedal and cleat position, seat height, seat fore and aft, seat angle, to stem length. Even pedaling technique and your weight distribution on the bike may need to be evaluated.

I hope this helps initially. Should you exhaust these options, I would recommend an MD who specializes in sports medicine for a physical examination and consideration of other options for diagnosis and/or treatment.

Marco Bosquez MD
Dr. Bosquez, AMSSM member. Consultant to the University of Texas athletics programs and Medical Director for the Austin Danskin Women’s Triathlon.
 

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date: July 30, 2006

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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