I have not changed shoes or cleat position so have been riding this setup for at least a year to year and a half. I am getting pain from the outside ball of my foot and runs about two inches down. I did tightened my shoe straps maybe that causing the problem not sure. Only hurts when pushing hard on the pedals. I run sidi shoes and look pedals and never had a problem in the past. Thinking maybe I am pushing with the outside of my foot could getting a shims help correct this problem?

You don't say how long you have had the pain. It could be just a minor injury that a day or 2 off the bike might solve . Have you got some other shoes you could try ?

I never pay attention to anything like that so I am thinking I have had the issue for 3 weeks. Now that I think of it I believe it started right after I tightend my shoes maybe a little too much. I guess the bigger question is how do I make it go away, I will loosen my shoe a little more hopefully that will help.

It might get worse because your foot will move, even just a little, if it's not properly tightened.

Louis

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I get similar pain if the front of the shoe is too tight. i prefer loose in the toe box and tight across the arch, just works for me.
Are you cleats worn, you may develop some rocking of the foot if the cleats are too worn putting stress on the outside of the foot.
Many things it could be though pretty much from the back down.

Same here.

I keep my shoes just tight enough to comform loosely to my foot. I reach down and tighten things up (I have BOA dials) if a sprint or hill jam is known to be approaching. But even a little bit too tight causes aching after an hour or so.

It could be that the shoe is too narrow for your foot, and that this problem only manifests when you tighten the shoe enough. I had a similar problem with regular width SIDIs.

i get the same issue on my right foot, if i tighten the shoes too tight. it's got boa laces, so it's easy to overdo it. i did try to remedy it with less, then more, then just different arch support, different canting, slightly different cleat positioning, to no avail. my arch is higher on that foot, but i think the pain was less with less arch support, cant pin it down. tried reshaping the insole too.
in the end, just keeping the shoe a bit looser (or "less tight", really) was the solution.