The Injurance Blog pt1 - Hot Foot & Morton's Neuroma in endurance athletes

In addition to our regular Endurance Blog, which covers topics related to endurance coaching and nutrition, we will also be publishing Injurance Blog, which cover common injury topics for endurance athletes.

We work in conjunction with A6 Physiotherapy and Axis Podiatry who contribute their expert advice for each blog post. If you have any questions, post them on THE ENDURANCE STORE Facebook Page, where this blog in posted.

Having competed in Ironman triathlon and ultra running events for many years, one of the common complaints I hear is 'hot foot'. It can affect cyclists just as much, if not more than runners. Often during Ironman, the problem can be caused on the bike and the proceeding run can be extremely painful. May people have said that they get a burning sensation under the forefoot which makes running so uncomfortable that they have to stop to take off their shoes. The pain is often described as running on razor blades. If you recognise this pain and it's something you've suffered, then our experts Samantha and Lindsay have the advice for you:

What is hot foot?

The forefoot pain described above could be on a spectrum from simple metatarsalgia (inflammation under the ball of the foot) at the less severe end, through to neuralgia (nerve irritation of the interdigital nerves under the foot), and right up to Morton’s neuroma in the worst case, which is a benign growth or swelling on the nerve caused by repetitive or prolonged trauma, which can result in severe excruciating symptoms.

The first thing to address with this problem is footwear. In particular the width of the toe box and making sure the cycling or running shoes are wide enough across the widest part of your foot. This is very individual to the athlete. Secondly, don’t forget there is more than one arch to the foot. As well as the arch which runs the length of the foot from the heel to the big toe there is a very important arch that runs across the forefoot involving the anatomy of the metatarsals and the met heads.

*The metatarsals are some of the the bones which form your foot, the end of each metatarsal is termed the met heads and they are positioned right at the ball of your foot. They're numbered 1-5 from big toe to little toe and this is the spot where metatarsalgia occurs (see image). 

If this arch is too low or you have ‘dropped met heads’ this can result in a real hot spot of pressure under met heads 2, 3 and 4 and could cause irritation to the nerves. An insole with some forefoot cushioning can really help and even better one with a metatarsal dome or pad that reproduces the transverse arch (the arch that runs across the forefoot), supports the metatarsals in correct alignment and stops compression of the nerves. If this pad can be customised for your exact requirements and individual foot mechanics and anatomy then all the better.

Podiatrists can use a gaitscan if a patient is complaining of these symptoms the scan usually shows the ‘hot spot’. This usually exactly correlates with the location of pain and means orthotics can be prescribed with the pad and correction in exactly the right place. These orthotics can be specific for cycling shoes or specific for your running shoes so this would depend when you get your pain or whether the cause of your pain is the bike leg or the run leg or even both.

Poor foot biomechanics whilst running can equally cause these symptoms because if the foot is functioning in such a way as to result in compression of the nerve then nerve pain or irritation will result.

Cycling is different to running as whilst most runners land on their heels and roll forwards to the forefoot, the pressure caused by cycling is directly on the forefoot. The cleat on the cycling shoe is directly below the met heads, so in effect when you push on the pedal, you are pressing the met heads down, resulting in them dropping as we described above. Sometimes adjusting your cleat position can help with the problem.

Calf stretches can be very useful as having tight calves is like permanently wearing heels and this results in increased forces through the forefoot. Something so simple can actually be the cause of a lot of problems within the foot. Self massage of the calves and using the foam roller can also be of great help.

We'd love to hear from you if you have suffered from hot foot during a running or triathlon event. Comment below this post on THE ENDURANCE STORE Facebook page and let us know your experiences and questions!