Anyone solved a persistent outer midfoot hotspot?

Hi everyone,

I’d like to get your thoughts on an issue I’ve been dealing with for around 10 years, and that I’ve never been able to fully solve.

I consistently get a hotspot on my right foot, always in exactly the same location: the outer midfoot (roughly around the cuboid / 4th-5th metatarsal area). It’s not joint pain, but a burning sensation caused by pressure that gradually builds up until it becomes uncomfortable.

The pattern has always been the same:

It mainly appears during sustained efforts in Zone 3 or above, such as long climbs or steady tempo riding.
It is much more likely to happen when the temperature is above 30°C (86°F).
It rarely happens during easy rides or rides with frequent changes in intensity.
It is always on the right foot, and always in exactly the same spot.

One interesting observation is that if I loosen the BOA dial and allow some air circulation around the affected area, the burning sensation disappears within a short time, even if I keep riding. Once I tighten the shoe again, it gradually comes back.

Another observation is that my feet don’t behave exactly the same. Using G8 insoles, my right foot requires significantly more arch support (L3/L4), while my left foot feels comfortable with only L2.

I also have a consistent difference in how I load each foot. On the left side I feel pressure distributed more evenly, with good support under the first metatarsal. On the right side I feel noticeably less pressure under the first metatarsal and a much stronger tendency to load the outside of the foot throughout the pedal stroke.

What puzzles me is that over the last 10 years, almost everything has changed, yet this issue has remained.

During that time I’ve changed:

multiple bikes with different geometries;
several professional bike fits;
saddle height and setback countless times;
cleat position;
completely different shoes (from narrow Sidi shoes to Lake Wide models);
different pedal systems;
several insoles, including customizable ones.

I’ve also changed: I’m older, my weight and fitness level have changed, and my pedaling style has evolved. Despite all of that, the problem still appears with exactly the same characteristics.

For context, I’m 54 years old, 170 cm (5’7”), 69 kg (152 lb), with an FTP of approximately 3.6 W/kg. I ride consistently and spend a lot of time in endurance and tempo efforts, so this is not an occasional issue but something I’ve experienced over many years of regular training.

The only consistent triggers seem to be continuous load and heat.

Has anyone experienced something similar?

I’m particularly interested in hearing from anyone who eventually found a less obvious cause, such as foot anatomy, arch mechanics, nerve involvement, vascular issues, or how the foot behaves dynamically under load, rather than the usual bike fit adjustments, since I’ve already explored those extensively over the years.

Thanks in advance!

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Anyone solved a persistent outer midfoot hotspot?