09/16/2017    Robert Scott Steinberg, DPM

RE: Treating Alpine Skiers with Pes Planus (Lawrence Huppin, DPM

I have been fitting ski boots and making ski boot
orthotics for 33+ years. I am a certified ski
instructor. Dr. Huppin listed many of the reasons
skiers call me for ski boot orthotics and custom
boot fitting. There is a lot he got right, and
went into great detail in doing so, but I caution
podiatrists about making ski boot orthotics
without being able to check center of knee mass
over the orthotic/ski boot.

Further, it is most often the compensated
forefoot varus that is the cause of foot pain in
ski boots, as well as medial malleolar pain, shin
splints, knee pain and hip pain. I have
completely eliminated these conditions by making
a corrective ski boot orthotic, in a ski shop,
where I can zero in center of knee mass, I also
look at knee tracking and then am able to do all
the extra boot fitting necessary, since the foot
is stabilized and the foot, ankle and lower leg
are "centered" in the boot.

I find no problem in making a ski boot orthotic
for the pes planus skier. Also, I have been able
to place my externally posted 15mm deep heel cup
running orthotics in my downsized ski boots, as
well as my externally posted 25mm ones. I did
this just to see if they would fit. When I tried
to ski with them, I was way off balance because
it negatively affected edge angle.

Having the orthotic flat at the heel is not good.
In a fully carved turn, plantar pressure occurs
from 1st MPJ back to the heel, with full medial
column loading. Heels should not lift in the boot
and since you cannot bend the bottom of the boot
like a running shoe. the toes should not be
trying to plantarflex more that just to provide
mild resistance to dorsiflexion. Skiers with
loose boots curl their toes, which fatigues the
foot causing all the problems.

The downward pressure through the medial column
of the foot comes from being able to "forward
press" the boot cuff, from the ankle. The other
thing to be watched is, except for very high end
racers, you do not want to lock the foot and
ankle. There must be a little bit of articulation
allowed in the orthotic creation.

Material choice is very important, considering
that whatever it is, is going to get very very
cold and stiff. So no, I would never want to ski
with my running orthotics.

Today's modern ski design and skiing technique
takes more than rolling the knees! In fact, in
the 2-day Professional Ski Instructors of
America- Rocky Mountain Division clinic I took
last spring, the trainer concentrated on fixing
our teaching methods. It seems the public, and a
whole lot of lazy ski instructors think, all they
have to do is get their students to "roll their
knees". Not so, and PSIA is on a mission to
correct that misconception. The amount of "knee
roll" should to be matched with the amount of
forward pressure you apply to the boot.

It is easy to pick out skiers who just roll their
knees with little forward pressure, because the
tips of their skis flutter. Their skiing falls
apart on harder snow, and of course, on head
walls. Looking for snow!

Robert Scott Steinberg, DPM, Schaumberg, IL

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