I was thinking of the angle when looked from the front. Like in this example:
If your foot is not perfectly parallel to the ground you will put more pressure on the outside.
Q factor could be an issue, its all track stuff I ride so quite narrow I'd have thought.
Interestingly that article does say "Also, if you are using those floppy insoles that come with most cycling shoes, throw them out and get a good insole that will support your arches better." so I think investing in some might be a good idea anyway.
If it is a Q issue maybe pedal axle extenders/ wider axle pedals?
put your legs up against a wall.. When I do my left foot is perfectly inline, my right tilts outwards.
I had the same hotspot pain as your describing until I put wedges between my cleats and shoe (not an insole).
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