Morton’s Neuroma in Cycling: Nerve Pain Between the Toes

Have you ever felt pain or numbness near the ball of your foot or under your toes? Sometimes people describe it as feeling a pebble or a rock underneath their toes. Others may feel a burning sensation, sharp pain, or numbness.

Morton’s neuroma is a thickening of the tissue around the nerves leading to your toes. The pain most commonly travels between the 3rd and 4th toe but others experience pain near the ball of their foot or between the 2nd and 3rd toe. Although the word “neuroma” conjures negative thoughts connecting to cancer, Morton’s neuroma is benign.

Causes

• Tight shoes: high-heeled shoes specifically are a risk factor. In cycling, shoes are commonly lower volume, which could pinch the toes together for prolonged periods depending on your ride duration. Considering the number of pedal strokes in a long ride, and the potential amount of massive watts you expend on your local group ride of death, cyclists could be at a higher risk.
• Foot abnormalities: people with bunions, hammer toes, high foot arches, or flat feet have a higher level of risk to develop Morton’s neuroma than others.
• Impact: The repeated trauma of your feet pounding the pavement via running also places you at risk.
• Foot Tilt: An often overlooked aspect in connection to Morton’s neuroma is the tilt of the foot as it relates to the connection with the pedal. When the foot tilts up to the inside (forefoot varus) in a natural position, more pressure exists on the outer rays of the foot during the pedaling cycle. This situation occurs in approximately 90 percent of the population.

Verification

If you experience persistent pain, we recommend visiting your healthcare provider to potentially diagnose the issue with a foot examination. They may recommend a foot x-ray to rule out whether you’re experiencing bone problems vs. another instigator.

Solutions

• Physical therapy: BikeFit trains numerous bike fitters who are also physical therapists. These extremely knowledgeable fitters specialize in both cycling and neuromuscular injuries.
• Find better fitting cycling shoes: Examine the toe-box and fit of your current shoes. Many people have wide feet and some shoes are extremely narrow. Although aesthetics in cycling may have led you to your most recent shoe purchase, comfort translates to increased power. Many companies like Lake, Sidi, Bont and Northwave, produce wider shoes. Lake produces “normal width” shoes that are already wider than many other companies, and they offer a separate wide sizing selection as well. Some local bike shops offer specific shoe and cleat fittings. If you visit your LBS (local bike shop) and request a foot fitting, they must examine the width and tilt of your foot to remedy pain sources.
• Wedging: Wedging is the solution to the foot tilt issue that causes excessive pressure on the outside of the foot.

A Wedge helps brings pressure under the first two toes, or as you can see from the illustration on the right, wedges spread out the pressure. This often relieves pain and discomfort. We strongly suggest that anyone who displays symptoms of Morton’s neuroma should examine the tilt of their feet.

You don’t have to feel pain when you ride.