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I've had intense pain in my right foot this summer (mostly in my big toe and ball of my foot) and after doing a lot of reading on the subject, I've come to the conclusion that there are any number of things that can cause it and any number of things that can solve it. Finding which one(s), can be difficult and costly. I would note that I have Look Keos and SIDI Zetas.
As others have mentioned, shoe fit and the shoe itself can cause foot pain and hot spots. Cleat position can make it worse or better, as can the insole of your shoe. I think my problem is largely caused by the fact that my foot swells a bit in the summer, causing my big toe to bump up against the top of the shoe. They otherwise feel fine in the rest of the year. My right foot is a tad bigger, too, which might explain why my left foot feels fine. I also think I may roll to the outside of my right foot a bit. There are inserts to help with that, too, but they seem to take up too much valuable room in my shoe.
I've experimented with new insoles (by Sole and another pair by Spenco that are supposesd to provide more arch support). They delayed the pain a bit but didn't eliminate it. I'm in the process of stretching the right shoe a bit with this contraption that will "bump up" the leather above my toe. If that doesn't work, I think I may have to try a different brand of shoe since SIDIS run narrow in the toe box. Beyond that, I'm ready to see a doctor.
I'd suggest starting with the cheapest fix and go from there, e.g., moving the cleat back and experimenting with different socks. From there, I would try a different insole (SOLE, Superfeet and Specialized Body Geometry are often recommended).
Live with intention. Walk to the edge. Listen hard. Practice wellness. Play with abandon. Laugh. Choose with no regret. Continue to learn. Appreciate your friends. Do what you love. Live as if this is all there is.
--Mary Anne Radmacher