Boot setup, alignment and balance with newly fused ankle?

A snowHead

Hello snowheads! I had my ankle fused 3.5 weeks ago and am researching boots and trying to educate myself on ramp angle, binding delta and forward lean. My tibia was fused to my talus but I still have my sub-talar joint and all of the joints in my foot are healthyso though I have very little range of motion in the ankle, I can still point my toes a little and should be able to use my overlap boots. I'm an expert skier, former racer (way back) from Lake Tahoe so the past few years I've gone from plug boots to Lange RS 130 and am using about a 8mm heel lift to open my ankle as I was bone on bone all of this last season and it was brutal! I love overlap boots and did not like my limited experience with 3 piece boots like Dalebello so I'm hoping I can still get in my RS 130 or I also just bought a pair of XT 130 which hopefully make it a bit easier to get in and out of with a heated boot bag and possible hairdryer. 130 Flex was a little soft this past season and probably more so now with my very limited ROM but these are probably about as stiff of boots as I can get into. I just bought some Zipfit liners and Nordica direct drive front spoilers so hopefully I can get the stiffness up to 140-150 without making them harder to get in. I'm 6' 190 lbs and ski fast and aggressive.

Some questions I have:

1. What are the pros and cons of internal heel lifts vs changing the binding delta with shims? The bindings on my 4 pairs of skis have a fairly low binding delta of 4-5° and I originally had a 1.5cm heel lift and that seemed excessive but the 8mm one felt about right prior to the fusion.
2. Before the fusion, the heel lift helped because I had ROM rearward so the lift opened my ankle joint and gave me more ROM before hitting the wall (bone on bone). However, now I don't have as much rearward ROM so it makes me wonder if I'd be better off changing the binding delta rather than internally with heel lifts or changing ramp ankle or forward lean. What is a boot fitter looking for to find proper balance on the skis and what is the best plan of attack to get them there when someone has an ankle fusion or extremely limited dorsi-flexion?
3. The reason I love Langes is how locked in the heel pockets are and Zipfits do a great job at this as well. But with a fused ankle, do you still want the locked in heel or do you really want a sloppier fit so that the heel can slide up to give more effective ROM?
4. For those of you skiing with a fusion, are you able to still shred bumps or are those days over?

Thanks so much for your help!

A snowHead

RedHi Red,
I'm sure someone will be along in a while with some interesting answers.
I was wondering about why you had your Ankle fused?

I'm wondering particularly as my ankle is getting more and more prone to arthritic pain...
Just too many motorcycle accidents as a teenager.

I'm a very keen skier and wonder what I'll do if I have to give it up.

Also welcome to the forum.

Well, the person's real but it's just a made up name, see?

Hey DrLawn,

3 years ago a suspension shop botched my suspension on my motocross bike and I shattered my tibia and broke my fibula jumping a triple (which I landed fine btw, but the guy messed up the compression on the suspension so it blew thru the stroke and went metal on metal leaving my ankles to absorb the hit). It was a Pilon fracture that required 2 plates and 16 screws. It was just never even close to the same and got worse and worse over the past 3 years from all of the MTB, motocross, skiing, etc. In all of my research, everyone with arthritis or other issues with their ankle joint wished they had done the fusion earlier rather than dealing with the pain. I kept putting it off because I thought it meant the end of skiing for me but the more I research, the more optimistic I am. It really does sound like a decent option and allows people to get back to doing most things with hardly any pain. Skiing is probably going to be more difficult but I do hear reports from people that ski really good with the fused ankle. Unfortunately, not many people share what the trick was to get their boots and bindings setup right to compensate for the limited ROM. That's where I'm hoping some skiers or boot fitters can chime in.

I can tell you that even a few days after the surgery, I already had less of that burning pain that I had while sitting so I can already tell it's going to be an improvement. Even though i'm only 3 weeks out from surgery it really feels like this was a great decision as before, just sitting on the couch I was in pain and now I have to be really careful getting up or out of bed because I forget that I'm injured since this pain is gone. I'm still not weight bearing so the real test will be in a few weeks when I get my xrays and can hopefully start walking again. I've already bought season passes for the family and booked a 6 week trip to Colorado for 2019 so I'm skiing regardless of how this ankle is. I just hope I can arm myself with enough knowledge so that I can work with a boot fitter to get this sorted out. I've spoken to a few and not all of them have experience with this type of injury so part of my questioning here is so that I can figure out which boot fitters seem to know their stuff.

Best of luck to you with your ankle and if it gets too bad, there are options. Ankle replacement wasn't an option for me as "I'm too active" and would wear one out in a couple years but for some people that can be an option and I don't think skiing by itself is bad for it but I do too many sports that are high impact for a replacement. The ankle is such a tiny joint compared to the knees and supports more weight so there may never be an ankle replacement that is even close to as durable as knee replacements are.

You need to Login to know who's really who.

@Red7, no real idea but see no reason why ziplining bumps is over?

Anyway, snowHeads is much more fun if you do.

You'll need to Register first of course.

@Red7, you clearly need to see a very high quality bootfitter. You don't have your location listed but I suspect you're in the US? If that's right, I would go on https://www.realskiers.com/ and look for the nearest specialist.

Then you can post your own questions or snow reports...

@Raceplate, a friend skis very well in all conditions and keeps up with everyone with one ankle 100% and the other 95% fused since early childhood.

Sometimes I think you are rather over opinionated.

Although seeing a good fitter is always good advice.

After all it is free

And I have never suggested to anyone that a zip line might be flat ... Puzzled

@Red7, while a good fitter is absolutely what you need, I think you’d find it more productive to post on one of the US centric forums, TGR for instance or ? Pugski ?.

You need to find someone who can actually look at your physiology.

You might get a good rec on here but it is somewhat Eurocentric by audience. And I am guessing you’re in the US.

My friend skis in really soft rear entry boots for ease of access and with his available ROM it doesn’t matter what flex. Not your case.

Also, as he’s been like that more or less forever, he has thighs of titanium and relies on those compensating.

I’d also be inclined to title the thread in a more useful fashion! I.e. “just had ankle fused, advice on set up?” Rather than going all over tech!

Good luck.

P.S. why would zip lining bumps be over?

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Thanks for the feedback!

The reason I'm posting here is to hopefully find people with fused ankles that can give some feedback regarding their setup or find boot fitters that can have worked with people with a similar condition. Advice for a fused ankle isn't a geographically specific issue and there seem to be so few people that have shared their experience of overcoming an ankle issue in forums that I think there could be people who frequent this forum that may have information to share.

I guess if I had one question to be answered it would be on internal ramp angle changes (heel lifts) vs external changes such as shimming bindings when it comes to a fused ankle. Any boot fitters or coaches on here that could bring clarity to this?

I will for sure be going to a boot fitter next season but want to learn as much as I can before hand because not all boot fitters have the same amount of experience and may suggest two very different directions to go. There are a number of posts where someone spent many days returning to the same boot fitter with their problem getting worse, only to find another boot fitter that found the holy grail. Not to suggest I have close to the same understanding as any boot fitter but if I can learn as much as possible, it may help expedite the process.

Plus in reality, achieving proper fore/aft balance can benefit all of us so I think it's a worthy discussion as I could learn from someone without a fused ankle that struggled with turn initiation, or whatever setup issue, and then shares what they found to overcome it.

Thanks so much!

snow reports

I was just searching for some info on "Ankle Replacement Surgery", and blow me if I haven't bumped into a thread I was on a couple of years ago.
Anyway ... anyone gone through the procedure of having a new ankle?

You know it makes sense.

I've had a few patients who are very active go through fusions. Can't offer advice on boot fitting but can agree with Under a new name - they all loved it once done and remained very active. These weren't youngsters either.

Help!!

Boot setup, alignment and balance with newly fused ankle?

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