Improperly positioned cycling shoe cleats or clips can cause knee pain, foot pain, numbness or burning by compressing the nerves between your metatarsals, the small bones in the ball of your foot. Erik Moen, a physical therapist specializing in the care of bicyclists, says the compression of blood vessels or foot muscles can also cause pain.
Expert Insight
Moen suggests that before you make any major adjustments to your cleats, that you test whether increasing your cadence and gearing down while riding affects your feet. The compressive force of pedaling slowly with power can cause foot pain. Check also that your cleat screws aren't digging into your feet inside your shoes.
Shoe Position
When your shoe is clipped into a pedal, the first metatarsal head of your foot should be slightly forward of your pedal axle. The first metatarsal head is a bone in the ball of your foot, aligned with your big toe. Sean Drake, an exercise physiologist working with the United States national cycling and triathlon teams, says cleats positioned too far forward can cause your ankles to move excessively and strain your Achilles tendons. Your feet should always point straight ahead, parallel to the bike.
Angle
Your cleat position should facilitate a natural angle among your hips, knees and feet, without the feeling you are twisting joints. Former "Bicycling" magazine technical editor Jim Langley suggests angling the cleat such that a line running straight down the sole bisects the cleat. However, you should adjust this angle after riding if it feels unnatural. Increase your cleats' float, which affects how much your feet can move while clipped in, if your feet feel pulled by the pedals. Decrease the float if you feel your feet and ankles move around too much.
Considerations
Richard Rafoth, of the website Cycling Performance Tips, writes that your cleat position should mimic your foot's natural position. That is, if you walk more with your heel up, your cleats should help you lift your heel slightly. And if you walk more with your toes up, your cleats should facilitate that position.
Alternatives
If you choose to use toe clips rather than clipless pedals, align the clips evenly on either side of the pedal so each foot touches the clip in the same position, with the balls of your feet over the center of the pedals. You may need to get different size toe clips if you can't achieve this with your current clips. If you tighten the straps, do so evenly on both pedals. The Southernmost Foot & Ankle Specialists website states that using a stiff-sole shoe improves the transfer of power from your feet to the pedals.
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