Unique Outcome with G8 Performance Insoles

Recently had a client referred to me for help with his feet in cycling. This is not uncommon as many people come to my studio to get help with foot/pedal interface problems. A visit with a Podiatrist confirmed Morton’s  neuroma and a referral to come visit Cycling Solutions to get the cycling shoes sorted. His issue was not initially very odd given how often people have Morton’s Neuroma and it causes pain, not just when cycling but in everyday life. He presented with pain in the metatarsals just behind the 2nd and 3rd toes or what is classic pain associated with Morton’s. He explained that while riding usually in the first 45 minutes, discomfort was bad enough to require stopping for a period to rest. This being his first season of riding he thought it was just normal discomfort of being a novice cyclist. Riding with some groups he learned this is not a common issue and there is no need to be in pain for every ride. My “standard assessment” (nothing is standard)  of his feet included a measurement of length and width, both weighted and unweighted as well as arch height. Also a complete inspection of his shoes and insoles as well as pedals and cleats. 

First observation in the assessment I found his feet similar in shape and form. Not symmetrical by any means but not much different from each other. Foot measurement showed a size 43 in a B width for both feet and a navicular height of a very tall 40-42mm. Pretty normal feet in a non-wide width but with a lot of volume or height. Under load these measurements held very steady without much foot shape or size change at all. This I found curious and made a mental note as we moved forward with the issues. 

Shoe and pedal inspection was a little more interesting. Shoes were an older pair of Shimano R241 custom fit with the heat moldable insoles that came with the shoes. Pedals were also Shimano, hulktegra as I like to call them, with yellow cleats and 6 degrees of float. Given the limitation of the mounting holes on the shoe the cleat was oriented directly under the ball of the foot even pushed all the way back in the mounts. Cleats were not badly worn and didn’t show signs of angular wear as a result of foot roll or a heavily varus forefoot. Insoles are where things got more interesting. The heat moldable insole while a great option for some was woefully inadequate in arch support for his feet. The insole looked like a triangular shaped foot stood on it, and stood on it hard. Ball of the foot and big toe , outside of the foot behind 5th metatarsal head and heel all squished down to nothing. The remainder of the insole looked brand new despite being more than 3K miles old. This was the indicator I was looking for from the beginning. 

The first part of my approach to his issues was complete. Now to start helping his feet be more comfortable in his shoes. Part of this involved changing the way he wears the shoes and part of it is changing the insoles entirely. First we talked about not wearing the shoes as tightly. Being a collegiate runner and wearing most shoes (including these cycling shoes) far too tight put a great deal of compression pressure down on his feet. Even standing in the shoes with less compressive force allowed his feet to “stand up” and not compress the arch while we talked. This showed the first signs of relief of many to come. G8 Performance insoles were next cut to fit and the largest of the adjustable arch supports was used. The level 5 arch is 34mm in height and was mounted pretty far forward for him to get noticable stimulation on the bottom of the foot. This is something he had never felt before. No shoe had ever had enough arch for him to even notice let alone provide proprioceptive feedback. More smiles and comments of how this was going to change the way he rides his bike. In addition to changing the insoles the pedal/cleat position was also an issue I wanted to address. We used Speedplay Zero pedals with a setback plate to get the pedal spindle back off the 1st metatarsal head about 12mm. These changes made a big difference and I suggested he ride for a few weeks and see how he feels out in the real world instead of the trainer. 

Feedback after a few weeks was very positive. He was able to ride 40+ miles (more than 2 hours)  before discomfort made him stop. I explained that there was still a need for a follow up and I wanted to see the wear pattern on the pedals and insoles.  He was pleased enough he did not feel it necessary. I insisted since it was part of the fitting and already paid for he should come back to the studio. 

Once he arrived I asked about the insoles first thing. He mentioned he no longer really noticed them but with the added mileage and time till discomfort he was pleased with the feel of them. I stressed again the importance of a proprioceptive response from the feet and the arch being critical to that response. I decided it was time to try something different. Using some silicone handlebar tape I built up the area right behind the metatarsal heads where his earlier mentioned neuroma was located. To my surprise he had no feeling of a change made to the insole. Going “all in” I built up the area over 20mm using several layers of silicone of various sizes and a traditional metatarsal pad to cover the whole thing once I was done. This was much higher than I ever would have thought necessary but figured while we are here lets just try. His first reaction was surprise. He described the feeling as “even”. He went on to say “ It feels like my whole foot is touching the shoe”. With some hard work and extreme effort I reproduced the custom work on the other shoe. The arches now noticeable and  pressure distributed more evenly across the base of his feet,  I felt better about the results we were going to get at this point.

Several weeks had passed and I had forgotten about the session. He called me out of the blue and my first thought seeing his number was “ Hope this is good news”. He was on a ride. I hear traffic in the background. He is winded and having trouble putting full sentences together. All I got out of the exchange before he hung up was “ I am 70 miles in and my feet just started to hurt. Thanks so much”.  I was a little stunned. He was telling me his feet hurt and thanking me at the same time?!  Then I realized at 70 miles he had been on the bike for almost 5 hours. Not bad given he couldn’t ride for 45 minutes when we started without having to stop because of his foot pain. We spoke later and he explained that after 80 miles and over 6 hours of riding his pain was back to where we were when this all started. He was very happy and ready to start training for a sub 6 hour century ride over the next few months.

This experience has made me remember a very important part of my fitting training. Never give up, never settle for “good enough”. Paul Swift is a BikeFit educator and mentor that likes the word “Try”. Too many people don’t try and in the bike fitting world that can be a very bad thing. When I try something different, even something strange or unaccepted as orthodoxy in this practice, that is when I truly learn something new in bike fitting.  I especially want to thank G8 Performance for their great product and BikeFit Education for their continued mentorship in fitting.