Morton's Neuroma During Cycling

A version of this article was originally
published in Triathlete Magazine

Foot and Lower Leg Issues on the Bike

Dear Tech Support,

I have been told by a doctor that I have a Morton’s neuroma and I am wondering what might be able to be done to help it during cycling, as it can be quite painful. Any ideas?

Melissa, VT

Dear Melissa,

A neuroma is defined as a tumor or overdevelopment of nerve tissue and Morton’s neuroma refers specifically to a neuroma between the metatarsals (toe bones) of the foot. Some neuromas initially create little more than a mild burning or numbing annoyance, while others can result in unbearably sharp pain at the point of the overdeveloped tissue. Women are more prone to Morton’s neuroma than men and this is thought to be somewhat attributable to the high heels and other restrictive footwear that women tend to wear. For similar reasons, a foot in a tight cycling shoe pushing down on a pedal can also be prone to developing a Morton’s neuroma.

A Morton’s neuroma most commonly occurs between the 3^rd and 4^th metatarsals. Non-surgical treatments of a neuroma tend to be more effective the earlier they are implemented after symptoms arise; if you think you might have a neuroma, have it diagnosed by a doctor and make equipment changes that can help you manage the issue as soon as possible. From an equipment and setup perspective the following five things are worth considering:

1. Foot Support – By supporting the arch and forefoot, nerve compression and pressure points can be reduced. As an added bonus, many riders will also see reduced fatigue and greater power production with a well supported foot as well. Consider talking with a podiatrist to figure out the best method of foot support for your needs on and off the bike. Make sure you get a footbed or orthotic that is made specifically for cycling shoes, as they can be quite different from a walking or running orthotic.
2. Wider/Higher Volume Shoes – With a Morton’s neuroma, you do not want your metatarsals restricted. Pressure on the forefoot will exacerbate the inflammation; get a wide and generous fitting shoe that does not put any additional pressure on the inflamed area. Sidi, Lake, Shimano and others make wide versions of their shoes and specialty companies like D2 and Bont offer stock and customizable shoes in a variety of width and volume options.
3. Stiffer Soles – Make sure your shoe sole is not too soft. Most modern performance oriented cycling shoes are plenty stiff, but make sure you are using a stiff enough sole as soft soled shoes can magnify pressure points.
4. Pedals with a Wide Cleat Platform – Generally speaking, road specific pedal systems with large cleats tend to work better than the smaller designs commonly used on spinning shoes and for mountain biking. Each pedal brand and design distributes pressure uniquely and thus experimenting a bit to see if one system minimizes pressure on the inflamed area over another can also be helpful.
5. Rear Mounted Cleat Position – Morton’s neuromas do not react well to pressure and standard cleat placement on a cycling shoe is often closely aligned with the point on the foot where a neuroma forms. If you have a neuroma, pulling the cleat away from this point will redistribute the pressure point and can reduce the inflammation. Most riders with a Morton’s neuroma will be best served by mounting the cleat further towards the heel rather than further forward. While a custom shoe will often be needed if you want to get the cleat significantly further back, Speedplay offers a rear mount adapter plate that allows any of their pedals to be mounted 1cm more rearward by just adding an aluminum plate.

Remember, early diagnosis and doing all that you can to take pressure off the inflamed nerve are your best chances of minimizing discomfort and further development of the neuroma. True interdigital neuromas rarely fully heal, but, caught early enough, can sometimes be managed well for long periods of time without surgery. Medically, use of cortisone (often not an ideal approach as the cortisone can atrophy other connective tissue) is a common non-surgical treatment, while removal of the inflamed tissue is the normal surgical solution.

Best of luck with the neuroma and I hope that equipment changes are enough to mitigate the issue for you. Ride hard and ride smart.

Ian