Applicability of Modern Podiatric Theories to Athletics and Athletic Performance

I can recomend you thoroughly read through the content on www.podiatry-arena.com frequented hourly by those who are leading the world in lower limb biomechanical research...I know their lack of skiing knowledge may be off putting, however, their theories are very valid and will assist you in developing a more sound biomechanical knowledge.

Reading through some of these threads I can confidently say quite a few of you need to visit this site... for example the correlation between forefoot to rearfoot relationships and pathologies is weak. You need to understand how Davis' law works and research the terms forefoot supinatus vs varus 'deformity'. Read the sagittal plane theory, subtalar joint equilibrium theiry (kirby), tissue stress model, etc. 

I am not writing this to criticise for point fingers, rather to enlighten you to the development of orthotics, lower limb biomech research and current theories. The theories you are basing most of you biomechanics on are by a man named Merton Root, DPM - an increadibly clever man who deserves all the praise he can get for developing a good theorie, however, with the aid of modern science and people building on his work things have changed significantly.

I look forward to chatting to you all about bootfitting and skiing biomechanics in the future.

regards,

Paul.

www.podiatry-arena.com - all you need to know for the latest on lower limb biomechanics, a number of the world leading lower limb biomech researchers post hourly on there.

skiing knowledge is not  great but most current theories can be applied to ski boots see:

Sagittal plane theory
Subtalar Joint Equilibrium Theory and Subtalar joint axis position.
Tissue Stress Model

Most of you whether you know it or not are discussing biomechanics and orthotics from the stand point of a man named Merton Root, DPM. I great man who probably has left the biggest influence on the podiatry/pethorithic communtiy. he has provided a building block for these more mordern theories.

Please research ff supinatus vs ff varus 'deformity', it can be explained by the Davis Law of soft tissue- long story short those who you think have a forefoot varus deformity almost always have a supinatus which should never be posted.

Had some experience with boot fitting but im sure there are those who are much more in the know than I. I would love to discuss with you ideal foot biomechanics in skiing etc

Regards,

Paul

I had a really long discussion of ff supinatus deformities typed up and when I hit preview it disappeared. So I'll reply very shotly here. You don't use a forefoot post for a ff supinatus deformity because that doesn't affect a cure for it (using Davis's Law to reform the soft tissue). However, podiatrists have a lousy track record of success in treating and curing most foot problems. Orthotics are notorious for not working, or only working for a short period of time. Is it better to accomodate a ff supinatus deformity by posting the first metatarsal head and medial side of the heel or is it better to only post the medial side of the heel in an attempt to allow Davis' Law to alter the soft tissue to correct the problem? As regards podiatry arena: it is useless for a lay person because lay people are generally not allowed to ask questions. Podiatry arena is a forum for podiatrists to discuss on an academic and theoretical level (rarely do I see practical conversations on there and when they do come up no one actually can come up with a permanent solution to the problem) and thus is beyond the scope of most people anyway. It is too inaccessible. Further, if you go through the forum and look for atetic related discussions, specifially skiing and snowboarding, well, you'll see very few and frankly when they do come up th doctors don't have a clue. They know little about anything outside of the foot, and a whole lot less about full body alignment, from the foot to the head. They are only concerned with the foot and anything that is not part of the foot is out of their realm. I would suggest that podiatry has such a high rate of failure because podiatristy on its own is too narrow of a field.

I apologize for the lack of formatting in my last post. I had it typed up correctly but for some reason the forum is lumping it all into one paragraph.

Oh and I also apologize if I am a bit harsh on podiatrists and podiatry arena. The doctors on podiatry arena are arrogant asses and neither of the two podiatrists I have seen have had a clue how to properly align my feet. I did all the research on biomechanics because of the failure of two podiatrists and an orhpaedist to even diagnose me, much less offer any treatment. One actually attempted topost the lateral side of my heel, which caused further pronation of my foot and nearly ripped my knee apart due to bad alignment while performing deep squats. His reasoning was to force the foot level, nevermind this fucked up weight distribution and caused my knee to track nearly 40 degrees to the inside of my foot. In addition to learning about the body I learned that podiatry is not the most well respected of medical professions, barely considered above chiropractors. I see many more people who are happy with what a bootfitter has done than I do people who are happy with their podiatrist. Did I mention that the success rate of podiatrist prescribed orthotics is pathtically low? What's even more sad is the numbers aren't reliable because no one trusts podiatrists (or even other doctors) to tell the truth about their success rate. Again, my apologies for being so negative.

Paul I just spent a bit of time on podiatry arena. Not much has changed since I last visited. I did see a discussion concerning whether varus wedges/posts are anachronistic or not and as I imagined no conclusion was reached. I also saw that you has a bit to say on the topic and overall it was a good read. What is your opinion of a varus wedge for the ff for minor overpronators in ski boots, not in everyday footwear? How much would that actually affect windlass function? Obviously it depends on the individual patient, but it seems that a generality might be made here. Why is it cycling coaches routinely use varus wedges to correct for supinatus and/or pronation? This actually begs the question: why is it that those involved in athletics often use methods and treatments that are anathema to podiatrists? I ask all my questions and make my comments with the greatest respect out of a desire to learn. I am a very direct and blunt person with not a lot of tact so I hope my somewhat rude nature is not taken personally. I am only this way because throughout my academic career I have had to be vey hard nosed in dealing with intellectuals because so often they are unwilling or unable to accept being questioned. As a side note, why on earth do the pods on podiatry arena cite themselves so often? Dr. Kirby does this constantly. I have read hundreds of his posts and rarely will he refernve another doctor's work, but very often he will use his own publications to support his arguments, which academically is a faux pas. You can't quote yourself! :D Anyway, I'd love to discuss this further and in much more depth. Perhaps we should start another thread for this? Also, since you spent 15 years as a fitter and over 5 as a podiatrist, I would like your opinion on whether or not podiatry is applicable to skiing? I ask because in discussions on podiatry arena, for example, you never see the doctors discussing the implications of their orthoses on leg, hip and spine alignment. However, if one were to fit an individual for a ski boot, not taking at least the alignment of the knees into consideration would be a mistake.

This thread was created from posts made to the Bootfitter forum thread by the same name: http://www.epicski.com/forum/thread/86910/becoming-a-bootfitter

The reason for moving the posts is conformance to Boot Fitter Forum Rules.

not taken in a negatively critical manner at all. I value your suggestions and will go through the podiatry arena site again. My biggest problem with podiatry arena is that they are too stuck on theory, especially Dr. Kirby who is mostly stuck on himself. I realize these are very well respected people who have helped many patients, but I am just not sure how applicable what they so is to skiing. I have researched the relationship of the ff to the rf, as well as the planes of movement the foot functions within (and sometimes without). Admittedly, I am not nearly so well-versed in these things as a trained podiatrist, so I won't try to argue along medical lines. I don't believe many of the theories are as applicable as you think and my reasonig for saying so is this: if you tried to apply many of the fixes concocted by podiatrists to a ski or snowboard boot I think you would end up with significant problems, qnd possibly the "corrections" might even make it impossible for one to ski without serious injury. There are plenty of people with $500 orthoses collecting dust in a closet because a good bootfitter has done a better job of improving the patients situation than a poditrist. I also am completely disenchanted with podiatry as it relates to athletics because podiatry does little, if anything, to improve athletic performance. I would go see a sports orthopaedist before I see another podiatrist for alignment issues from the feet to the head. Another issue I have with podiatry is how it relates to the biomechanics of the foot and body. As far as surgery and medical knowledge goes, of course podiatrists have that in spades. What most don't have is a background in engineering. They lack the necessary knowledge of physics and mechanics to fully treat the foot. In fact if you read through podiatry arena there are plenty of references to "having to think like an engineer" because podiatry cannot solve the problem on its own. Further, the podiatrists on that forum seem to have a disdain for having to "think like an engineer" and they aren't very good at it anyway. Dr. Kirby is full of himself. He rarely concedes that any other podiatrist's theories are as valid as his and then he quotes and references himself to prove why. This is not the mark of a true and thorough researcher but rather it is indicative of a monstrous ego that is unwilling to concern itself with the ideas of others'. He is obviously a brilliant and talented podiatrist who has help a lot of people and helped to further podiatry, but as a layperson it is hard to treat him credibly because of the way he presents hi self on that forum. The forum itself is an excellent resource, but I think the people there are stuck in their own narrow little field and often cannot see the forest for the trees. Since you have been both a fitter and are now a podiatrist, how do you feel about the application of podiatry to athletics? More specifically, to skiing and cycling? In my research skiing and cycling are furthest apart from what podiatric theory recommends, yet cycling coaches and ski boot fitters have a track record of success that cannot be ignored, despite often doing exactly opposite of what a podiatrist might recommend. What about prescription orthoses? I do not see how anyone could perform on any real athletic level using the orthoses I have seen. The foot is a complicated structure that is not prone to structural modification at an adult age. I am not sure why podiatrists persist in trying to use orthoses to correct and "cure" the problem when it has been shown in a large number of patients to simply not work. It seems that accomodating the foot in the position that is most comfortable and accomplishes the goal of the individual patient is the more logical route. I challenge any podiatrist, using accepted medical theories within podiatry, to design an orthotic that will enhance a skiiers performance as well as what a good bootfitter could do. Consider canting a ski boot. The cant in effect is a large, full length varus wedge. A varus wedge is contraindicated, as you point out, by modern theory. What would a podiatrist do differently to correct for the canting problem? Thanks for posting your thoughts and opinions. I am really interested in seeing how this discussion goes.




Edited by Superhero - 10/22/09 at 1:08pm

Cirque. Could you also change the topic of the thread to better suit the direction it has take ? Maybe something like "applicability of modern podiatric theories to athletics and athletic performance" or some such?

urgh! kill me, i posted a massive reply and i lost it!


going to say that there are a lot of pods who dont know wtf is going on - but orthotics do work and there is plently of well constucted studies to prove so.

superhero can i suggest you do some more reserch:

- find out what supinatus really is and how it should be corrected and find the differnce between ff varus and supinatus
- find some well documented reserch into the efficacy of orthotics
- understand the consequences of ff posting on the 1st ray (hint: its going to dorsiflex it)
- the differences between cycling, running, and walking...and skiing too! but its much harder (probably most like late midstance in walking)

I will post again - probably not till sat ... so busy atm sorry.

I am here to discuss and debate... not preach!

but i will recommend the following

craig paynes biomechanics boot camp lecture/notes (see bottom of page for notes) - it is very evidence based:  http://www.portaleducation.com.au/presview.asp?id=57

LTU's skeleton pod biomech lecture notes:
http://www.latrobe.edu.au/podiatry/pod1pbmdesc.html
http://www.latrobe.edu.au/podiatry/pod2pbmdesc.html

Recommended threads for students:
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=2219

Kevin Kirbys Precision intricast newsletter collections - i know you don't like the way he talks on Pod-arena but these books are a must read.
http://dpmlab.com/html/bookreview.html

Join JAPMA to acess all journal articles and reserch papers

Read www.podiatry-today.com for another pod biomechanics style forum.

See www.e-podiatry.com for more reference material.

just a start some cost, some cost wads of cash and some are free! read read read

sorry my post fkd up it was much more structural.

paul

ps i am not phil on podiatry arena.

interesting discussion, fallscreek-hotham, i think you will find many of the boot fitters on the board are amongst the readers of podiatry arena, i for one was a fairly regular visitor but recently got a bit bored by the way many of the discussions were going, that and being told by some pod who worked with skiers 20 years ago that modern equipment and technique made no difference to set up..well that was a joke!!!  that said i have been very busy recently and not spent much time doing anything other thna working

on the FF varus/supinatus discussion most of the problemms i see are from soft tissue tension, and most of the big ff varus posts i see on footbeds/orthotics occur on weight bearing systems when the ground reaction force pushes up on the 1st ray during the moulding process... there also seems to be a difference in what is seen dependant on what side of the country you get trained on.... east coast seems to see lots of varus west coast lots of valgus in the forefoot..... now is this the population or prehaps the training

superhero, kevin Kirby is a top guy i have met him a couple of times and drank beer with him and ken whitney several years back, on the orums i don';t think he comes across as well as he could, i would recomend his pricision intracast books they give some really interesting case studies and make understanding different biomechanics problems very well

BTW i thought you wanted to be a boot fitter, sounds like you want to go a lot deeper

fallscreek: I know the difference between ff varus and supinatus. I have posted my understanding of the difference several times. My issue with contraindicating a varus wedge, either for just the FF or as a full length wedge, for athletics is that if you attempt to correct a supinatus with a valgus wedge in order to reform the soft tissues, you end up having precisely the opposite of the desired effect. That is, if you use a valgus post or wedge in a skiboot you increase weight on the lateral side of the foot, thus exacerbating the problem on snow. I agree with the treatment of a FF supinatus via a medial heel post or skive combined with a ff valgus post in daily footwear in order to facilitate soft tissue adaptation via Davis' Law, however I don't believe doing this in a skiboot will have positive effects for the skiier. I think the treatment should depend on the goals of the individual. The biggest problem I have with using a varus wedge in a supinatus ff configuration is that you limit the rom available o the foot when dorsiflexed, as it seems to jam the talus into either the calcaneus and/or the fibula. To accomodate for this limited rom I think a heel lift might be appropriate to restore rom. These are my observations concerning the topic. What do you think? What would you do for a mild equine foot attempting to ski? How do you feel about minor bowlegged (mild genu varum) people having a varus wedge used to accomodate the inverted position that seems to be predominant in this leg shape? CEM: Dr. Kirby has a nearly impeccable reputation, that I do not dispute. In the context of pod arena I simply don't feel he is accessible to someone that might not be deemed his "equal" as he tends to be dismissive. I do have a great deal of respect for him as regards biomechanics because he realizes the many shortfalls of podiatry in this field and acknowledges the fact engineers have a much stronger training background for this type of work. I do want to be a bootfitter. I see my knowledge of biomechanics as being especially limited and am simply trying to learn the basics.

And I still can't get the forum to save the format I write in. I apologize for the difficulty in reading my posts due to the lack of paragraphs.

CEM I am familiar with that poster on pod arena very very cringe worthy! I hope that you return because I enjoyed ur posts. Ur thoughts on what superhero is saying?

btw superhero i reread one of your posts and i believe that you need to seperate ur own personal experiences with pods with those who are in the know...most dont have  a clue about bootfitting and dont pretend to...but i believe bootfitting can be improved with an enhanced biomechanical understanding of how the foot functions.

For ,if you think that a client is sittng in their skii boot in too much of a pronated position you can take a step back and assess like a podiatrist would and you could establish the position of the STJ axis - this inturn will indicate where you want to apply the supinatory foot. You could do a jacks test and assess windlass function. STJ and MTJ range of motion, Ankle dorsiflexion...etc etc...

A ff  valgus post does more than 'correct supinatus' (no one really bothers to do this it just happens when you reduce the supination moment acting on the distal-medial collum) a valgus wedge facilitates windlass...there are alternatives to valgus posting like reverse mortons, kinetic wedges, met pads etc. you are missing the point with supinatus that is a symptom no a cause, supinatus only shows how much force is acting on the medial column...which is caused by proimal issues i.e. a medially deviated STJ axis or the difficulty/inability to facilitate windlass.

remember if you want the stj to supinate you want the mid tarsal joint to evert/pronate and vice versa.

I think windlass is still very important to skiing. for both the average joe seeking comfort and high performance skiiers.

That said, I can see how you might want to invert/evert the foot relative to genu varum/valgum it is something I believe needs to be explored. in which case why wouldnt you just cant the sole of the ski boot and deal with any foot issues seperately?.

I think cycling is very different to skiing also, one thing is in common is the goal of linging up the ankle and knee joints to make cycling more efficient...but in cycling you have no orther choice but to correct in the forefoot because that is the only place which is experience a ground reation force...and what you are attempting to do has nothing to do with the foot. 

I don't believe it is important to 'balance rearfoot to forefoot relationships' nor does anyone who has a sound understanding of the modern theories of podiatric biomechanics.... and yes you need to think like an engineer.

Have you looked up any of the recommendations i suggested? What did you think?.

I also recommend you stop taking general stabs at the podiatry profession with the development of research technology it is evolving at a rapid rate ---those whom you have had bad experiences with are  living in the past are not the ones on podiatry arena...the research conducted is being used by more than podiatrists (its not like some secret that only pods know).

For the record I would love to conduct some research how the foot functions inside a skiboot and the ideal position for the foot to be in its why i am posting here.

I think superhero i think you are trying to run before you can walk...go back study ur anatomy, learn about windlass, learn about biomechanical asssessments and what they mean.

how do you suppose the talus jams with the calc the two joined to from the stj? ...but i think i know what ur saying...yes a heel lift would be the solution...but ur getting mighty bulky in ur boots...

if u wanna align the foot/ski with the lowerlimb then just cant the boot. if you want to improve fit and function of the foot inside the boot then use orthotics how would you achieve what you want to inside the boot use podiatric biomechanics!


Edited by fallscreek_hotham - 10/24/09 at 1:47am

i think you have done well to teach urself superhero...but i think you need to go take a step back and relearn a few things. read craig paynes lecture notes they are free! buy kevins books they will explain everything you need to know.

im not saying walking and skiing are the same...but i think you can apply these theories to achieve what you want to inside the boot. u may want to varus post the forefoot...but you need to appreciate the potential effects on the plantar fascia and windlass. just like when valgus posting you need to be aware of the valgum you may or may not be creating...that said you can often supinate the rearfoot by incorperating valgus posting which would actually improve lowerlimb alignment.

i really encourage you to stop trying to use forefoot to rearfoot relationships to justify your inboot treatment, start thinking about windlass, tissue stress and Stj axis location...they form the basis for orthotic prescription...forefoot to rearfoot is old hat.

and to be a good bootfitter you need to know ur anatomy! from bones, ligaments, blood supply ,nerves, dermatomes, muscles, roms etc etc

Alrighty I'm not trying to reply on my phone so this should be much easier!

I probably should separate my personal experience with pods from others.  After all, each pod is an individual and deserving of being treated as such rather than lumped into a group.

I agree that bootfitting can be improved with a good biomechanical understanding of foot function.

How important do you think windlass function is in a nearly stationary foot in a skiboot?  I do agree than an evaluation of the STJ axis is important - it can determine a great deal about foot geometry and function.

I see, I wasn't aware that a valgus wedge would help to facilitate windlass.  Interesting.  I need to break out my anatomy books and focus more attention on that.  I do know that supinatus is a symptom and correcting the root issue is the first step in restoring (or initiating) proper foot function. 

So supinating the MTJ effects an eversion of the ff?  That makes perfect sense.  How about limiting factors in the STJ such as ROM and joint flexibility?  Treatment should also focus on those aspects, yes?  Some stretching could be quite useful I would imagine.

I'm just not sure, with my admittedly and obviously limited knowledge, of how windlass function is that important in a skiboot?  Could you explain this further please? 

haha well yes, my stabs are not fair, and as I already mentioned I should probably leave my personal experiences out of it.  No doubt about that.  The irony is that my actual academic training is very much centered on objectivity, which I am not always able to apply as well as I'd like.  It doesn't help I've been very stressed over the last few weeks, but that is no excuse.

I think extensive research of how the foot functions when nearly immobile within a rigid skiboot could be of great value.  I know research and studies have been done before, but from what I have been able to find most of it is dated and could use updating based on modern podiatric theories. 

Yes i'm not sure if I expressed what I met about the calc being jammed, but you seem to understand what I'm trying to say.  I really think it is fascinating how the foot functions.

I'm pleased that I was able to evaluate the effects of the ROM limitations when accomodating a varus heel or ff foot position, and yes any significant heel lift could start getting bulky in a boot.

I see your point on where to use what.  For the record I agree with you, but I think a combination of the two might prove the most useful to skiiers.  I understand the difficulty that applying a wedge of any type (or really any orthoses) within the boot could cause significant problems.  The slightest change in the orthotic can lead to significant changes in the mechanics of the foot.  However, in defense of myself, it has been noted in many cases where patients have used the wrong orthotic in the wrong foot and have ended up being better off for it.  Orthotics and their use is still most definitely an art.  I believe this is due to the fact that each foot is unique, and there is no way to come up with a general truth that applies to all feet as regards specific function and specific, individual feet.

Thank you for the detailed response!

Thank you for the compliment, and of course I have a great deal still to learn.  The mechanics of the body keeps drawing me further and further in and I can't seem to learn enough as quickly as I'd like.  Yeah, I'm a total dork, I know.  I knew I should have stayed in pre-med when I was doing my undergraduate work...

I have read some of Craig's lecture notes, and I have also gone over some of Kevin's (you are referring to Kevin Kirby of Sacramento, CA yes?) publications, though I have not yet had the time to give his books the full treatment they deserve.  Bear with me, I am often having to cross reference with other texts in order to insure I have a full understanding of what is being discussed. 

Posting the varus ff could lead to serious mechanical problems with the lever action of the foot, specifically with the first ray and probably the second ray as well.  For people who ski irregularly this might not be a significant issue, as time spent in the boots is rather limited, however, doing so in everyday shoes could lead to even worse pronation problems than were seen initially.

How would supinating the rf allow for better lower limb alignment in an already pronated foot?  Wouldn't this cause even more pronation, as well as additional stress on the lateral side of the knee and medial ligaments of the knee?

Wouldn't a valgus post, by definition, create some degree of valgum or am I misunderstanding something here?

I'm really not trying to use rf and ff relationships to justify in boot treatments.  In fact, in some cases it seems couterintuitive to do so.  It just happened to be where the conversation was at the time, if I remember correctly.  I don't think I know enough to justify much of anything yet.  lol

I also don't feel I am unrealistic about orthotics.  I actually feel that the emphasis placed on orthotics is much to great, and that there are other ways to deal with foot alignment.  As an example, in a moderately pronated individual one can actually look to the hips to see if there are any issues there causing misalignment.  If the hips are rolled forward, as can often be the case, it can cause pronation of the feet.  Merely improving lumbar function and improving the posture of the individual can place the feet into much better alignment both within the foot and in relation to the rest of the body.  Obviously this isn't the case all the time, but just an example.  I believe there is a lot more to foot function and alignment than just looking at the lower limbs. 

In the US particularly I think there are a lot of cases where there really isn't an alignment issue in the feet or lower limbs, but rather it is a postural issue that needs to be addresssed before attempting to change anything in the boot.  Muscle strength imbalances, poor flexibility and imbalances in ROM can all cause significant problems in gait and foot function.  Correcting these issues can sometimes completely resolve problems that, upon first look, may be blamed on the feet.

I appreciate you taking the time to share your knowledge and also your patience with one new to the field.  :)

 Falls creek,
I am interested in your comments as you mentioned windlass a few times and I have a question, how does this test apply to skiing as we have a solid sole boot where the toes never raise up and there is no toe off like walking?  Just wondering how this assessment has any application in skiing?  I ask this humbly, I seek knowledge.

For what its worth , I know two guys pretty well that are both podiatrists and skiers and when I have talked to them in the past about alignment and canting they look at me like I'm nuts.  Neither of them associate any real merit in any of this.

I think boot fitting alignment is a huge part of skiing as well as you can.  I expected the podiatrists that I know would have had their boots all set up. I went on a ski trip with these guys years ago and the one doctor bought new boots and threw the stock insole out but never replaced it with a real footbed.

IMHO all the money that is spent on ski equipment, a couple of hundred  more for  a good footbed and alignment services will be the best money you can spend.

we need to stop trying to draw a line between ski bootfitters and podiatrists...pods know more about the feet and boot fitters know more about skiing and ski boots....bridge the gap!

precisely the reason i studied pedorthics rather than podiatry..... that and the state of the podiatry profession in the UK is not what could be described as consistant, i didn't want to spend 3 years studying corns, calluses and how to make an orthotic from felt and foam

if more podiatrists even understood footwear then the world would be a better place, on that note pedorthics or something of similar nature should be included into the podiatry courses, (it may well be in the US but not as far as i know in the UK)

Agreed CEM! but i do believe the pods here in australia are well trained and well informed. I think if you wound the clock back more than 10 years they were not, can't speak for uk pods but what u are describing sounds like they are 20 yrs behind the times! these days there are orthotic maunfacturing labs and classes within the schools, and the schools themselves are producing some great research. As for the shoe knowledge i think that its somthing a good podiatrist just needs to seek some experience with for themselves (aside from shoe mods theory being inclded in the course)

what are your thoughts on windlass function during skiing?

i am not sure if it is entirely activated by i think it is important to keep in mind more much the plantar fascia is being loaded - its got to be in the top 3 of complaints in bootfitting.

i don't see to many people complaining about PF loading in skiing EXCEPT when the footbed has been made in weightbearing with the toes jacked up into what i describe as a forced windlass... all this does in invert the forefoot and create a false FF varus...which your friendly poorly trained boot fitter/podiatrist then fills with a FF varus post

the other problem i see with this is the arch created is so high that it is very dfficult to get any pronatory feel thoughout the turn and makes it increasingly difficult to release the edge

i had this discussion a number of years back with Howard Dannenberg, a colleage asked him his views on weight bearing footbed syatems and windlass...he looked at this guy like he had come off a differnt planet

BTW you are right re Austraila /UK

Superhero, Cem & Fallscreek give you good advice to stepback emotionally and utilize analytical and research skills.  Every professional brings to their profession a focus and interest.  The reason they do what they do, the reasons and purposes are vast.  This includes podiatrists. 
 
I have personal experience with Dr. Kirby, as does my child.  Overall physiology,health,  biomechs, and athletic performance from the foot up are his passion and focus with indepth knowledge and continued study. He is a multi-disciplined skier and athlete. Many podiatrists have different concerns or focus,  which is probably why many pods refer patients to Kirby for evaluation & custom orthotics.  Dr. Kirby is pretty straight forward and doesn't add fluff.  He is thorough in evaluating patients' biomechanics & movement.  My experiences with him are of a caring skilled professional, not the attitude you seem to have experienced on a forum.

He made an interesting comment to me, which I think applies to many things I read on this forum.  " There are many children who's feet issues are not addressed.  Causing them pain not just in the foot, but ankles, knees, hips or spine.  This puts them on the couch, learning to be coach potatoes because being active & running around hurts. If the foot issues were properly addressed, especially early on, these kids would enjoy pain free activity & enjoy their lives a lot more."

I am guessing here, but I think it's a clue as to why it costs FAR less than $500. for an exam, custom orthotics, and all follow up appts. and any adjustments when a person goes to see Dr. Kirby.  Highly affordable to get a child or person out of their pain caused by foot structure or soft tissue issues.  Much cheaper then running the gamut of off the shelf or specialty store products or other medical treatments that don't get rid of the pain, at the source.   It is also heartening when he will examine your custom ski boot insoles and proclaim them a perfect fit for your biomech needs. My son & I both enjoy our athletic pursuits, as well as our skiing, pain free (except for the occasional bruises rec'd.) 

Follow Cem's & FH's advice, keep reading, thinking, questioning, analyzing.  I just can't help but point out the irony of someone called Superhero complaining of  a Doctor being arrogant and egotistical.  Seems the name & perceived attitudes rub against each other a bit ?  

I have already addressed my hostility towards pods. It's buried in a lot of other unformatted writing so I am not surprised you missed it. Superhero is self-deprecating, believe it or not. You'd have to know me personally to understand. :D Yes, Dr. Kirby has a fantastic reputation, no doubt. I have already said so. :) CEM, fallscreek: Generally, how do you fit for someone with "duck feet"? Formatting will probably be non existant. I am using my phone again. Can't afford a computer. *sigh*

911 ur spot on he is a top guy!

Depends where the "duck feet" are coming from, is it external rotation of the hip or is it abduction of the forefoot.as an example:  if it is the latter then i would have to look at the feet, is there navicular drift/drop. if it is navicular drift (navicular drifting medially) i would punch out the area on the boot and look to address the rearfoot with a wedge or skive. then depending on the sucess and the severity then punch the lateral shell of the boot. CEM?

CEM in terms of major complaints i did mean the ones that intially come to you with 'boot issues'. 'my arches hurt' kind of clients...not the ones you would carefully select boots and footbeds for.

CEM when precribing for ski boots what are ur general goals and common prescription variables? i.e, cast dressing etc and also are you aiming to get them to 'neutral' ? (i hate to using the term for gait, but it might actually fit with skiboots!)

In the case of navicular drift are you saying you would punch out the ski boot near the navicular?  Would you then place EVA or some other material there to prevent the lateral movement of the navicular bone? 

In the case of excessive navicular drop would a simple "arch support" generally be the route to pursue?

arch support with a skive/ varus heel wedge/ or a CAD/CAM heel rotation...navicular drift can be better controlled in the rearfoot...as for eva no ur trying to create room of the navicular. if it drifts in the boot it will result in the foot being pushed laterally and an increase pressure on the lat side..

Varus heel wedge yes, but I have seen various devices made my pods (I think even referred to on podiatry-arena as being useful) designed to fit between the top of the shoe and the medial side of the navicular to prevent the drift.  I don't understand why you would want to allow the navicular to drift, because that can really mess with alignment no?  Especially in a ski boot?

Am I missing something here?

show me the reference? does not make sense...a medial flange would be wayyy too big for a boot