foot pain after biking

by Amy
(Salt Lake City, utah)

I took my husband hiking about 2.5 months ago up a fairly steep trail(in the mountains). Afterward, the right side of his right foot was hurting, felt bruised and sore. Since then, it has gotten worse. It now hurts the entire top and bottom if his foot. May be slightly swollen but it's hard to tell. He is overweight and also has mild diabetes(not enough to take insulin). There is no visible bruising. He says it hurts more when walking for awhile and also when he wakes up in the morning. What do you think it might be?

RESPONSE

Hi Amy,

I am going to go out on a limb here and assume your husband was wearing biking shoes. Even if he was wearing sneakers the same problem could occur but it would be more likely with the nature of a biking shoe which tends to have a thin sole and also happens to be narrow.

In biking the bottom mid portion of the foot sits on the pedal and so most of the pressure exerted on the foot occurs in the mid portion of the foot.

In a situation where the shoe is too thin and certainly if it is too narrow in the mid portion of the foot, what happens is an irritation to the bottom outside of the foot may occur at the level of what is known as the fifth metatarsal base and the bone just behind it, known as the cuboid bone.

Look at your husbands foot and ask him where the most sensitive spot is. If it is in the area where there is a flare to the foot, usually about halfway between the base of the toe and the lateral malleolus which is the outside ankle bone. This flare in most people will be somewhat closer to the ankle than the toe.

This is the area of the fifth metatarsal bone. When a biking shoe is too narrow or too thin, it puts a tremendous amount of pressure on the base of the metatarsal and can aggravate the bone.

In addition, there is a tendon known as the peroneus longus tendon which passes down the top outside of the foot and at the level of the cuboid-fifth metatarsal base, it makes a quick "turn" and goes under the foot all the way across the foot.

Because of the "turn" that it makes and the location of the "turn" it is subject to shoe pressure. Again, thin soled shoes and very definitely a narrow shoe in this part of the foot will irritate this tendon.

That is two possibilities. Another possibility is a subluxed cuboid bone which is much more difficult to diagnose. The constant pressure of the foot against the pedal may have slightly displaced the cuboid, a finding which is very difficult to see on x-ray, and since the cuboid bone is now out of position, it hurts to walk.

The last possibility although remote would be a fracture of the fifth metatarsal base. Again, anything is possible.

Since we are talking about such a small area of the foot and so many possibilities it will be impossible to know for sure unless you see a foot specialist.

The problem is your husband is overweight and just the simple act of walking on the foot does not allow the problem to resolve itself.

Since he is diabetic, albeit diet controlled, he certainly wants to make sure that he avoids foot issues that can lead to more severe problems.

Ten weeks is way too long for this problem to still be present and it tells me that it probably will not go away on its own. Its time to seek medical attention.

Marc Mitnick DPM
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