Saddle causing foot pain?

[sundial]

For the first couple of miles, I found I was slipping around and having to re-settle myself on the saddle, but other than that, everything felt great. At about the fifth mile, I started going numb again, but this week, by mile six, the inside of my left ankle and the top of the foot were in excruciating pain.

Couple of questions:
1. Is the seat post up too high?
2. Are you using SPD's?
3. Does the saddle have a cut-out for the girlie parts?