Ultra racing and feet – numb toes

My only injury from the 2018 Transcontinental Race was my toes. Having finally made some progress into the cause of my issue and its treatment, I thought it may be useful for others to hear of my experience. Please note this is simply my own story. It may not be medically correct or appropriate for others.

First of all, what happened?
During the race, I never had any pain, or particular discomfort in my feet or toes. My shoes were and continue to be comfortable, correctly sized and efficient in use. But at the finish in my hotel room in Meteora, I discovered that the tops of my toes, in particular my smaller ones were numb. It didn’t affect walking, cycling or any other activity, it just felt strange walking barefoot, and noticeable in certain cicrumstances such as pulling bed sheets over my feet.
The numbness has faded, but even a year later has not fully disappeared. If I wear tight fitting shoes, my toes will tingle or numbness will temporarily return. I find myself kicking off my shoes in the office and whilst driving for long periods.

I have a history of flat feet going back to my childhood. I have needed orthotic insoles with arch support for years. Without them, the soles of my feet start to ache and hurt. I could not walk long distance or even stand for long periods without increasing discomfort. https://www.aliexpress.com/item/32850788458.html?spm=a2g0s.9042311.0.0.4b304c4dpG7Jl7
When running, I am an excessive pronator, my feet rocking inwards. This is apparent while cycling also. Without the insoles, my ankle bones could even graze the cranks on each down stroke. Of course I used the orthotics on TCR. So what went wrong?

Looking for answers
The first discovery was through a physio appointment at my work. They suggested that the Metatarsal arch was also in need of support. When I pressed down in my shoe, the metatarsal heads (first toe knuckles) would be flattened, putting them under excess pressure and the nerves would suffer from repeated bruising, leading to numbness. This described perfectly how my feet felt they were behaving, flattening into my shoes especially when pedaling harder. When running downhill, my feet would always feel like they were sliding forward in my trainers or walking boots.
A potential compensation was to add metatarsal pads to my existing insoles. I purchased these cheaply online https://www.shoeinsoles.co.uk/podotech-pu-metatarsal-pad-for-insole-express-kits.html and spent quite some time determining the best positioning. Some of these attempts led to quite extreme pain. During this time I wasted some money with a podiatrist consultation. The lesson here was that I should have sought a specialist sports/cycling podiatrist as the consultant proved ultimately useless.
Eventually I found the sweet-spot for positioning the pad and I replicated this in all my footwear.
I was now able to cycle and run successfully with the pads in place.

Secondly, some off-road riding using eggbeater pedals which offer a lot of float, showed that my feet naturally like to point toe out. So I have adjusted my cleats accordingly, perhaps reducing pressure on my smaller toes on the side of the shoe.

Testing on a 1,000 mile, 2 week cycle tour offered a promising outlook, yet still I did not feel I had the complete answer. My left foot in particular was always less comfortable when pedaling. I googled exercises, cleat shims etc and then came across something called Hammer Toe.
This is when the toe joints become inflexible, a hammer shape develops and the end of the toe ends up taking much of the force when pressing down the foot.
My left second toe seems most affected, so much so that I wonder if I have broken it at some stage in life.
The solution that I’m now employing, apart from exercises, is a silicon gel, hammer toe cushion. https://www.shoeinsoles.co.uk/pro11-gel-hammer-toe-support-crests-pair.html I’ve been using this when cycling and it has certainly offered much comfort to feel almost as good as my right foot. I got a pair for £2 on ebay!
The combination of orthotic insole, meta-tarsal pads and toe cushion is looking a promising solution.

The final option is to consider shoes with a larger toe box, such as Lake.
My winter cycling shoes do offer a little more room for my toes. With my improved insoles, they don’t feel a bad or loose fit. Whilst my ultra shoes with summer socks don’t feel like they are pinching my toes too much, perhaps my feet swelled during the race?Unable to find a local stockist, I ordered some shoes on-line. Luckily, I hit the correct size first time and I now have a pair of Lake CX237 (size 43)
They do have a more generous toe box than my Specialized Expert (Size 43) and the first uses on the turbo has been encouraging. Of course I can’t use them outside yet, here in the dreadful UK winter weather!

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Probably the best advise for anyone would be to seek out experts to diagnose a condition and recommend treatment. I’m a bit stubborn in that I like to do research and fix things myself. This is more than likely a spin-off from my mechanical attitude. When I did pay good money for expert advice, I clearly made a bad choice of who to use!

Given that I did not have the toe problem in all my training for TCR goes to show how extreme an event it is. The race WILL highlight any issues and for sure TCRNo8 will tell me if my DIY treatment has been successful!

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