Toe and/or foot numbness is a common problem among cyclists that often involves more than one root cause. In my experience with patients, I have found that it stems from either one or a combination of these three sources:
1. Poor Fitting Shoe
Our feet swell during cycling, due to increased blood supply demanded by muscle activity. Most often, athletes with toe numbness are wearing shoes that are too small, or are tightened too snugly at the beginning of the ride, which restricts blood supply to the nerves, thus causing the numbness. With the advances in cycling shoe construction and closure systems, it is easier than ever to find a shoe with multiple points of adjustment that accommodate variances in anatomy. Additionally, a prefabricated insole or custom orthotic can help with supporting the foot to maintain a stable position throughout the pedal stroke.
2. Poor Bike Fit
The aggressive time trial riding position for triathletes can increase the stress on the lower back and pelvis. Physiological limitations such as muscle tightness, strength imbalances, leg length discrepancy, or even a Morton’s neuroma (enlarged nerves between the metatarsal bones in the foot) can all lead to strain on the nerves that exit the back, eventually leading to toe numbness. Ensure that your hamstrings and hip rotators are flexible and that your core is strong and stable. Consistency with exercise off the bike also pays dividends in peak performance and comfort on the bike. I firmly believe in getting a proper bike fit with physiological testing, regardless of complaints of toe numbness.
3. Poor Cleat Positioning
Poor cleat position tends to be the most common issue I see leading to toe numbness during cycling. Ideally, the center of the cleat (where the pedal spindle interfaces with the cleat) should be positioned just behind the ball of the foot for most comfort (some will recommend as much as 5mm). Too often, a forward cleat, coupled with a “mashing” pedal style often seen in triathletes and time trial specialists, increases the pressure under the ball of the foot where the nerves are most susceptible to being compressed. Check your cleat position (or better yet, get a bike fit with cleat adjustment) and make sure you are not feeling pressure when you apply force through the pedal.
Casey Maguire is a Los Angeles-based orthopedic physical therapist who has treated professional triathletes, cyclists, and multiple athletes in the NBA, NHL, NFL, and USTA. His focus is on functional biomechanics.