|
|
|
Search
09/21/2017 Scott Carlis DPM
Treating Alpine Skiers with Pes Planus (Lawrence Huppin, DPM)
My many years as a ski boot fitter helped steer me towards my career in podiatry. I wanted to add a few additional thoughts to the in depth article by Drs. Huppin and Scherer as well as the comments by Dr. Steinberg.
For those podiatrist that see skiers or who get ski boot related questions from patients I want to provide some basic information on the design of ski boots and the most common adjustments made to ski boots by a boot fitter.
As podiatrists, we are asked to make recommendations about dress shoes, running shoe, cleats, dance shoes, sandals and the list goes on. Basic knowledge about ski boot design will help you look like rock star to your patients who are lifelong skiers or those just getting into the sport. Skiing is an expensive sport and you want your patients to be comfortable and enjoy themselves while they are chasing their next powder day.
Are all ski boots the same? The shape of the boot varies by manufacturer, just the same way shoes vary by designer. Ski boots are designed with varying forefoot widths or lasts. Boots also vary in instep height, leg volume and overall stiffness. In general boots get narrower in all areas and have a stiffer flex as they move from entry level to recreational to racing boots. Higher end boots are typically stiffer and are made from more uniform durometer materials. These points in design are important when it comes to accommodating deformities in the foot and ankle. A good boot fitter will want to work with the best shell to accommodate deformity. This does mean that your patient may have additional cost and get a more advanced boot in order to accommodate their foot shape.
How can a boot fitter make the boot more comfortable? The most common areas that boot fitters make accommodations are the forefoot area for bunions, Taylor’s bunions and people with history of neuromas. The navicular area and medial ankle are often stretched for all foot shapes, not just the pes planus foot. As the boot narrows into the ankle and heel pocket this can be the tightest part of the boot. This area also contains the hinge bolts connecting the upper and lower shells. This portion of the boot design can make a ski boot uncomfortable for any foot or ankle shape. In many cases, the corrective orthotic is not sufficient to pull the foot deep enough into the heel pocket or keep the medial aspect of the foot and ankle from rolling into the shell.
Will my running or dress shoe orthotics fit into my ski boots? Ski boots are sized very differently than running shoes and hiking boots which often have extra room in the toe box. A ski boot is often sized down from a running shoe. I wear a size 11.5 running shoe and a size 9 ski boot. The smaller the boot the more control you have over the ski and less intrinsic stress, as discussed by Dr. Huppin. Clamping the forefoot buckles tighter will not relieve the intrinsic stress if the boot is too big. People can be comfortable in a smaller ski boot due to the small amount of posterior translation of the foot while flexing the upper cuff of the boot. This motion will move the foot deeper into the heel pocket and pull the toes off the front of the boot. Due to the sizing and shape of the ski boot a person’s regular orthotic may simply not fit into the ski boot.
What materials should I use for the ski boot orthotic? With regards to the materials of the orthotic I find that a 1-2mm subortholene or flexible graphite to be sufficient. You do want some flex in the device for assistance in loading the edge of the ski. Rigid running type orthotics can in a way overcorrect a patient in their ski boot and keep them from the optimal knee over the center of the boot position that Dr. Steinberg mentioned. I have not found an orthotic heel cup to be a problem with regard to fitting into the heel pocket of a boot, but I would likely stay away from deep or extra deep heel cup. I do like to make full length covers with an EVA or Ucolite. The orthotic should replace the insert that comes with the boot, just as you would replace the insert in a running shoe. Full length covers allow for heating devices to be installed as well.
If you see patients who ski, I recommend establishing a relationship with your local ski shop just the same way you do with the local running shoe store. Talking with the head boot fitter can provide you with great knowledge and likely some referrals. Dr. Huppin is right that ski shops are often the first place someone goes when their feet hurt in their boots but if their pain does not go away after a few days they need to be seen by a specialist like us. -THINK SNOW! Scott Carlis DPM, Renton,WA
There are no more messages in this thread.
|
|
|
|