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Strange podiatry advice...?

 Poster: A snowHead
Poster: A snowHead
Consulted a very well regarded podiatrist and biomechanics chappie after seeing the local podiatrist for some new toe joint/bunion pain, and being referred on for some reason. Physio also though that it might be worthwhile, given my knee pain.
Now, I have for 20+ years been advised to have, and therefore worn, decent arch supports, prevent pronation, etc etc. (Including by NHS podiatrists and various boot fitters.) Obviously have them in my ski and boarding boots, done by reputable fitters.
But this guy says no, you don't need and shouldn't wear arch supports. You have a high (and flexible) arch, your knees don't point inwards that much, your ankles are very flexible (well, side to side, not in skiing terms unfortunately), and pronation is normal.
And then he put 7 mm of padding under the outer front side of my foot, just back of the little toe, instead... So now my knees are banging together, my arches are unsupported, my feet are rolling inwards and, God, it feels weird! But apparently I'm walking better.
I wondered if the idea was to strengthen up something but, no, he said it would correct my foot position and take strain off the ITB and Peroneal nerves/muscles which are indeed getting tight and irritated.
Who do I believe??? (Just to make it clear, not actually asking you lot for expert advice - unless anyone is an expert, if course, in which case input is welcome; just more another "aaaaagh!" experience.)
I've obviously got to give it a trial for a few weeks - though very not keen to rip out the custom insoles in my ski boots, really...
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Whom to believe indeed! There is a school of thought which says that the foot's arch is a natural structure capable of balancing the body's weight dynamically in almost any circumstance, so arch supports and footbeds just interfere with the natural mechanics of the foot. That's the barefoot running school, and there is a little bit of evidence that it works. Another school of thought, maybe the more traditional one, argues that the ski boot is an unnatural and restricted plastic environment so the foot needs to be supported and mated to the technology of the boot and ski.

There's not much real evidence on this either way, and lots of anecdote on both sides. That probably means that the only person to trust is yourself - see what works best for your own skiing. And in the meantime, we can hope that someone working in these fields will be able to rigorously test their claims.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
My inexpert opinion, is that "for skiing", you need to be standing "square" on your skis, so they are flat on the snow ie. not on inside, or outside edges.

I'm sure the body can compensate a bit....but not enough to sort a pronounced problem. My Wife's A Frame was only cured with alignment

I have no idea if that is best for use outside of skiing.

Apologies if I have answered a question that you haven't asked.
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@Old Fartbag, Square on the skis, square to the snow and with knees aligned when flexed and not strained. I had certainly previously found arch-raising insoles to help a lot with knee alignment which inner and outer thigh muscle 'training' alone wasn't achieving. My knees, particularly one side, have a tendency to fall inwards if I don't actively remember to 'make' them parallel, another thing which I could do without having to remember whilst descending a steep slippery slope. Of course, perfectly aligned knees, achieved in this way, may not be what my body is happy with (see other thread on aching outer lower legs).
Mind you, there's also the canting aspect of boot cuffs, which I'm no expert on at all; never sure if one should correct at the foot, arch or ankle end, or maybe leave that be and adjust by the cuff. Most bootfitters seem to like the former, certainly before the latter: but is it the correct sequence, and why?

@diaphon, (with apologies for the poor grammatical form) good points. And I'd thought that the days of faffing around with boots and insoles were nearing a (positive) end. Sigh...

I think that my podiatrist does not deal with skiers; more runners and marchers in his area. Seems to be very keen on the foot being placed and moving correctly for walking, but not necessarily convincing me that he's looking further up the knee and leg chain. But we shall see - if not by skiing, at least in walking/mountain boots.
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Quote:

Mind you, there's also the canting aspect of boot cuffs, which I'm no expert on at all; never sure if one should correct at the foot, arch or ankle end, or maybe leave that be and adjust by the cuff

My understanding (which may be wrong as it stems from back when my OH was getting alignment done) is that canting the cuff is not designed to correct anything, just to make sure the cuffs follow the natural direction of your lower legs. My OH had bandy legs and in uncanted boots he couldn't keep his skis flat (very obvious if going up a draglift behind him). He had lifts under his bandings at one point (done by Hugh Money of BASS in Les Gets, yonks ago). He had "right and left" skis after that. I get the impression that there's not so much of that about these days - but again, that might well be wrong.
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@Grizzler, it's a huge hassle dealing with boots and insoles! And it's probably reasonable to have one solution for your walking shoes and a different solution for skiing. There are a few podiatrists who specialize in skiers, for example there is a fellow called (appropriately) Armando Podo in Les Menuires whom friends have had very good experiences with. Good luck!
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
I slipped into my 5 year old Salomon boots in 2004 and for the first time ever my feet hurt like hell I.e. They felt fine for the 5 years previously.

Conclusion: my arches had fallen in the off season, resulting in ill fitting boots, insoles and achey feet.

Solution: custom fit insoles (nice leather topped, heat moulded ones I got fitted for in Andorra)

Result: boots that then fit like a glove, with no pain whatsoever, and a skier who skis like a champion!!

P.s. Ok, I might be exaggerating with the champion thing Wink
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
What feels better? The person who reccomended that is likely right.

The other thing I'd say is that a lot of foot problems seem to come from weakness. If the knee or ankle aren't tracking properly the foot will often end up rolling.
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You'll get to see more forums and be part of the best ski club on the net.
motdoc wrote:
The other thing I'd say is that a lot of foot problems seem to come from weakness. If the knee or ankle aren't tracking properly the foot will often end up rolling.


Quite likely, yes. And when you go and try (emphasis sadly often on try) to locate a knowledgeable trained person or 3 (or many more) on this, and get several don't knows (cause and/or solution) and then contradicting advice, comments and solutions...?? That was my initial point.
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 Ski the Net with snowHeads
Ski the Net with snowHeads
Personally I'd go and see an athletic therapist or personal trainer and get their advice.

If you want my advice for free it's squats. Lots and lots of squats - they must be done properly though. Wonders for alignment issues. Do some YouTube trawling.
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@motdoc, athletic therapist? Personal trainer? What them???

Squats - them I do know. Laughing Lots of. Many varieties. About to go and do more now. (See acl threads...) Don't help feet. Can hurt misaligned knees.
I prefer inner & outer thigh strengthening and alignment training. Was going great until someone kindly removed my knee ligaments Confused
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
As a severe pronator, which I was first alerted to when buying my first set of ski boots 25 years ago, when the fitter had to escalate my fitting up the experience chain as I was outside the metrics for their footbed moulder in the shop, I saw a leading podiatrist who managed to write a four page essay about my feet for my orthopod consultant! She prescribed custom made footbeds and instructed me to wear them in all shoes, and obviously my ski boots. I see her every few years to check and tweak if necessary. HOWEVER, while they deal with the symptoms by aligning the ankle properly and stopping tibial rotation aggravating the knee I still need to tackle the structural weakness by doing excercises to strengthen the feet and ankles, and my PT has me doing some of these barefoot. However, in answer to the OP, I would not, could not do without my custom footbeds in my boots.
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
As a severe pronator, which I was first alerted to when buying my first set of ski boots 25 years ago, when the fitter had to escalate my fitting up the experience chain as I was outside the metrics for their footbed moulder in the shop, I saw a leading podiatrist who managed to write a four page essay about my feet for my orthopod consultant! She prescribed custom made footbeds and instructed me to wear them in all shoes, and obviously my ski boots. I see her every few years to check and tweak if necessary. HOWEVER, while they deal with the symptoms by aligning the ankle properly and stopping tibial rotation aggravating the knee I still need to tackle the structural weakness by doing excercises to strengthen the feet and ankles, and my PT has me doing some of these barefoot. However, in answer to the OP, I would not, could not do without my custom footbeds in my boots.
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 You know it makes sense.
You know it makes sense.
Well, I gave up on the new padding on Saturday night. Can't say I noticed a positive difference out walking on Friday in my stiffish walking boots without insoles, but when I came to put my normal 'street' boots on to go out Saturday night (sad, bumming around the house or garden in slippers most days at the moment) I not only flopped straight inwards at the ankles but couldn't even wear them without all 4 outer toes on 1 foot immediately rubbing against their uppers and causing pain. Took off 7mm felt, went back to old arch supports and 2 pairs of socks; comfy fit, happy night out.

Don't think that the new suggestion's going to work for ski boots somehow: low enough toe volume for me as it is!
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
@Grizzler, My take is that changing the alignment of the foot works differently in ski boots to other shoes as the ski boot cuff restricts what your lower leg can do. Why not try it ?

I trim back the alignment strips that I use in my ski boots so that there is nothing under the forefoot to reduce space for my toes.
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 Poster: A snowHead
Poster: A snowHead
@rjs, I might try it - but a 7mm lift + insole is a heck of a lot of space in small boots where my flexible toes already brush the top.
Also, having spent a lot of time and money messing with many pairs of boots and having them and their liners all set up by 'experts' (who have also assessed my foot and done footbeds accordingly, and not spotted this issue or solution), I'm more than loathe to start messing all over again. Taking bits out at the front is going to change all sorts of stuff, I'd imagine, not least foot angle and thus ankle flex, weight distribution etc.
I was reasonable happy as I was, and have finally found some boots that I'm happy(ish) with, so I think I'll pass on more changes for the mo, at least until I can get a consistent opinion and explanation. Given Saturday's experience (and today's, doing exercises with old insoles with wonderful supported balance) I'm far from convinced that this podiatry 'expert' really knew his stuff. I have an NHS podiatry appointment which has finally come through re the toe/bunion pain, so I'll ask them; also have physio check up re knee, so ditto. Might be going to ski boot shop at some point soon to get some more boot cuff reducing done, so can also pick their brains.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
I have custom made insoles, from a podiatrist, to alleviate pain in the outside of the ankle. If I don't wear them the pain returns, especially if I'm participating in sports, eg, before insoles I would have had to have stopped playing hockey, with them I'm fine. The muscles in my legs have adapted to their new (old?) position and I find that if I wander around barefoot I end up with calf aches.

I have Superfeet heatmoulded in my ski boots and have wondered about ditching those and transferring my custom insoles each time (would need boots reset, of course)

Cut to the chase... Like Thorney, I can't imagine skiing without some sort of arch support - all my leg muscles would be "wrong" ?

@rjs, the ski boot may restrict calf muscles but it must be advantageous if those muscles are working from a stable platform that they are already adapted to? Harder to make them relearn for a different sport and then go back to a neutral position once you take the ski boots off?
Just chatting, not arguing, I'm a recipient not a provider in this sphere.

@ Grizzler - 7mm on the outside of my foot and I'd be confined to bed and phoning for a second opinion!
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