Cleats and calf/knee pain?

Gals,

I noticed that my right foot continuously thought the cleat was too far forward, when actually the cleats on both shoes were in the same position. I'd point my foot down to slide further into the shoe but that would not do the trick.

I moved the right one back about 3mm, felt better, but the foot wanted more, but alas, that is the end of the cleat, so to speak, no more than 4mm can be done, and I'd like some more. (I use look cleats with the necessary 3 hole bore in the shoe)

Particularly after a recent 7hr ride with the most climbing I've ever done, an old ache behind my knee from the beginning (when I was starting out with a standard double) came back - the strong tendon that comes down from the thigh on the outside - as well as an ache on the outside attachment of my right quad, above the knee.
Borderline hypochondriac as I am, I think perhaps it also radiates into the sides of my calf (those two small stringy muscles there).

Can this be? Can having the cleat wrong by 5mm cause such a difference?

My left foot is perhaps a quarter-size larger, but nothing as dramatic as 6 mm.

It can dear, It can..Even only on one side..

When i purchased my new shoes I had to play around with the cleat position and I ended up getting it wrong one day. OW. OW OW. The reason I could tell was from the nasty pain on the left side of my right knee and in my quad.

Yes. (Those muscles/tendons in your calf would be your peroneals). But it also sounds like you have some some functional asymmetry going on. You might be dropping the hip on the other side, which causes you to reach farther with the injured side. Since you are maxed out on that cleat, you may want to try lowering your saddle a touch or moving it forward to alleviate the reach problem, and think more about whether you are sitting squarely on the saddle. I've had a similar problem, though not nearly as extreme in terms of cleat position, but the problem starts with my hips being functionally asymmetric. Eventually, I developed peroneal tendonitis. I was treating that tendonitis with PT, but nothing was helping for long. Then we discovered that my right SI joint was out (one day when I complained of an ache down my IT band and hip/pelvic pain). We started addressing that problem, and the calf has stayed healthy.

Another reason I suggest moving the saddle a bit is because you are straining yourself even more under load on hills. That suggests to me that maybe you are trying to drop your heel more than you can, and you wind up hyperextending that knee a bit, which causes the posterior knee pain. You of course don't want to aggravate the top of the other knee by going too low or too far forward, but you might be able to find a position that is a happy medium.

Also, go to cyclingnews.com's fitness Q&A page and look up the responses relating to functional asymmetry and cleat position. You may want to try moving the nose of your saddle a little towards the good side, which will force you to sit over to your bad side more, shortening the reach there. The fit expert on that page can explain things a lot better than me.