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Metatarsal pain, teenaged skier

post #1 of 19
Thread Starter 

Hello all,


I am hoping to get some insight into an ongoing problem that my 15 year old daughter has been having with metatarsal pain and swelling caused by her ski boots.  This started with the purchase of a pair of Salomon Instinct boots about 2 years ago.  Mildly annoying at first, then got really painful during a 7 day trip to the Rockies and some really intense skiing.  We have been around the block with several bootfitters in the shop where we bought them, all with no success.


I'll give you some facts and background (maybe not all of it relevant to the problem), then posit a hypothesis as to what I think is the problem, and you guys can tell me if I'm on the right track or should be focusing on something else.


The Condition:

- starts as dull pain and numbness after about 1/2 hour of skiing; 

- when she takes her boots off for a break after an hour or so, some swelling is evident, pain is initially sharper, then eases somewhat from being out of the boot;

- rest of the ski day is tolerable, but at boots-off at the end of the day, feet tingle, sharper pain, which subsides after a while, almost as if they were thawing out (same kind of sensation);

- the swelling forward on the sole of the foot, between the metatarsals and toes, center of the foot;

- the right foot is worse;

- when the problem first arose in spring of 2012, the swelling had a distinct round shape, a dense lump about the size of a large pea; but now it's just a general swelling of the whole area; puffy, soft;

- she also has the same problem in her cycling shoes (mtn. biking).


The Skier:

- 15 year old girl, 5'6", 125 lbs, very strong skier, all mtn., goes anywhere and everywhere, loves high edge angle carving, very athletic;

- narrow feet, high arches, moderate instep height

- skis with a relatively upright, balanced stance; neither weight-forward nor backseat


The Boots:

- 2012 Salomon Instinct, custom shell type, 90 flex

- shells and liners were heat molded at time of purchase

- current footbeds are a new model by Sidas (off-the-shelf, non-custom), called Winter 3Feet High Arch, which have a metatarsal ridge running fwd. from the arch; they support her arches well, and keep the ankles in a nice neutral position; previous footbeds were Sidas Volcano and A-Line, neither of which had enough arch support.

- fit in the boots could be snugger; doing a shell fit shows about 1/4" space on either side of the forefoot (not ideal); length is good with 1-1/2 finger fit w. toes touching end;

- I have had to pad the heel area to take up some room there

- forward lean is quite pronounced; much more than some of the newer boots (eg. Lange RS/RX; Tecnica Inferno, etc.)

- hard to tell if the boot ramp angle is more than others, as my eye isn't trained to judge that.


Past things that we have tried to correct the problem include grinding down the front part of the bootboard to give more space above the metatarsals, removing the heel shim widget to reduce the boot's ramp angle (and adding padding there to take up room at the side), remolding the shell, and trying different footbeds.  None of these helped much.


I am down to the point now that I am thinking that these are just the wrong boots for her.  My educated guess is that there is too much forward lean in the boots, and the ramp angle is too great.  The clue is that when asked where her weight is distributed when in a ski stance, she says that she feels all her weight bearing down at the front of the feet.  On her skis, this would be exacerbated by any binding ramp.  The fact that she has the same problem in her cycling shoes is another clue that this is where the problem lies, as all her pedaling force is bearing down on the shoe's cleats, which are of course directly under the metatarsals.


As a test we had her try on my wife's Lange RS boots, which have a much more upright cuff, and it changed her perception of weight balance to an even distribution over the entire sole of the foot, from heel to metatarsal, incl. arches.   


So, the question is (after the long preamble...thanks for staying with me here):  am I on the right track, in thinking that the Salomon is unsuited to her and she needs a more upright boot to get better balanced and get the weight off the forefoot? Or am I way off base, and if so, is there something we can do to tweak the Salomons and make them work for her? Such as a custom footbed? (is that even suitable for a teenager?).  


It would be great to get some insight before we spend more time and money on new boots, and the problem persists.  Looking forward to hearing back from some of you with your experiences and opinions.  Many thanks in advance!


post #2 of 19

take out the bootboards, and take pictures of what the top and bottom of the toe area looks like. post those pictures here.


is there anyone near where you live that can assess the ROM in her ankle joint in dorsiflexion?


the instinct has a fair amount of forward lean in the shell. this could be a factor, however you need to cover the 2 points above first. if the bootboard is ok, and her ROM in dorsiflexion is normal, then take a look at reducing the forward lean of the instinct shell. the spoiler can be lowered and or the top of the spoiler can be heated up and flared.


does she have "athletic calfs" you know like an female shot putter on steroids? if the calf is especially large or deep into the boot cuff, that can be exaggerating the forward lean of the boot. also get rid of any of the junk that is taped to the liner behind the heel that is potentially pushing the foot further forward into the toe box. if she needs more heel hold down, replace the junk behind the heel with a tongue shim in front which will give better heel hold down by pushing the foot further back and down.



post #3 of 19
Thread Starter 

Hi Jim,


Thanks for the reply.  To answer your questions...


The boot board is normal -- when the shop ground down the front part, they took it off the bottom, not knowing that that part sits in a recess, leaving it unsupported.  The bootboards then cracked, and I had them replaced with a new pair.  No mods have been done to the latter.  If you still want pics, I can post, but they are just stock Instinct bootboards.


She has normal calves -- she is very athletic, but quite slender.  Definitely no shot-putters calves there. :)


We know some people here who can check out her ankle ROM.  She actually has had a couple of ankle sprains (soccer injuries), one of which was a bad one.  This may have affected flexion.  We'll get it looked at.  Curious to know, how would this impact metatarsal pain? Heel lifting off the boot?


There is nothing taped to the back of the liner behind the heel.  I did add some padding to the sides of the heel below the ankle, but this will not affect fore-aft position.


Good tip about adding padding to the tongue to hold the heel in place.  We are skiing tonight, and I will ask her for feedback on what is happening back there.  If there is lift, I will take that advice.


Also, I like the idea of trimming the spoiler.  I'll definitely do that before we ski tonight and see if that sets her in a more balanced stance.  I can probably trim about an inch off.  Not sure how much difference that will make to her stance, but it's worth a try.


Finally, I just inspected these boots, and it appears that the instep buckles can be repositioned so that the buckles are angled rearwards.  I will do that today too and see if that helps the heel hold.

Edited by SGN - 1/24/14 at 8:07am
post #4 of 19

just for the fun of it---measure the circumference of her calves at the top of the liners.


also, is she over tightening the lower 2 buckles because of the slim feet?


with a 1/4 inch of space, width wise, on each side of her foot, I suspect she may be.


this will pressure on the top of the instep and pinch a nerve up there causing numb toes.



post #5 of 19
Thread Starter 

Hi Mike,


Yes, she does tighten the instep buckle quite a bit.  On my suggestion, she recently tried skiing with it much looser (very light finger pressure to close), but she couldn't ski like that.  That lasted one run. She had no control, so tightened it back up again.


Question:  with the Custom Shell panels on this boot, is there any way to heat them up and snug up the forefoot again? Basically reversing the initial molding process?


I will measure her calf and get back to you....


Looks like we won't be skiing tonight after all due to bad weather here.  Too bad, as I wanted to try a couple of mods to see if any improvement.

Edited by SGN - 1/24/14 at 11:18am
post #6 of 19

that's why i asked about the bootboard first. common problem of grinding the bottom so it no longer mates with the shell cavity. also i have seen the top overground so that the first and fifth metatarsals sit on the ledge of the shell while 2,3 and 4 drop down below them.


restricted ankle ROM commonly presents itself as pressure at the forefoot. in some cases even skiers with high level of feeling, cannot tell that the heel is being levered off the deck and all of the body weight and g forces from turning are being carried by the met heads. balancing the foot pressure to the ground can be done with a combination of ramp angle and forward lean. what is key is the net angle between the ramp and the shells forward lean.


custom shell only moves one way. and judging from your description of her forefoot width, it did not move any direction when molded. it only moves where it has been pushed by the hard and boney parts of the foot that are fighting for space in the shell.



post #7 of 19
Thread Starter 
Originally Posted by starthaus View Post

that's why i asked about the bootboard first. common problem of grinding the bottom so it no longer mates with the shell cavity. also i have seen the top overground so that the first and fifth metatarsals sit on the ledge of the shell while 2,3 and 4 drop down below them.


You're right on.  After the grinding, the bottom of the bootboards were unsupported, then cracked, making them sag downwards, which of course left them no longer flat.  Note that this grinding was done after the initial onset of the pain, so it was not the original cause.  It just made it worse, probably.


Thanks for the insight into how the Custom Shell works.  No solution there, clearly.


What you say about ankle ROM makes sense.  It could be that her past ankle injuries have locked things up there, and may be why one foot is worse than the other.  We'll have that looked into ASAP.  May even do a quick assessment here at home tonight, just to get an rough idea.


Some good feedback here so far.  Thanks guys!

post #8 of 19
Thread Starter 

OK, so we had time this afternoon to do a quick ankle flexion test here at home.  Hopefully it will be meaningful.  Test was done using a plumb bob held against the top of the tibia just at the base of the patella.  Standing in bare feet on a hard floor, I asked her to flex each knee forward just until the ankle started to lift.  Results as follows:


- right knee was able to flex so that the plumb bob touched the floor about 1 inch forward of the big toe.

- left knee flex was about 2 inches past the big toe, so about 1 inch further than the right.


I'm sure this is not how a physiotherapist or pedorthist would check this, but maybe you can glean something from it.


Interestingly, the right leg flexes less, and it was the right ankle which had the worse sprain.  Makes sense that it would flex less.


Let me know if you have any comments.  If this is good enough for your needs, then I will not bother taking her to a specialist to get it checked further.


Sorry Mike, I did not have time to measure around the calf.  I'll do that tomorrow and get back to you.



post #9 of 19
Thread Starter 
Well, I have been corrected as to how to properly measure ankle dorsiflexion ROM - thanks Jim! Here's what it looks like:

- right foot, 1 inch
- left foot, 1-1/4 inches

Measured floor to sole of foot below 5th metatarsal, foot on floor, 90/90/90 position, ankle flexed. Foot size being a factor, her shoe size is 7-1/2.

Mike, I also measured calf circumference at top of liner - 12-3/4 inches.

I hope these measurements are usable. Let me know your thoughts.

I also had some time this weekend to make some modifications to the boots:

1) flared out the spoilers with a heat gun and cylindrical lever, gaining about 3/4" space back there, and making the inside surface of the spoilers now vertical; her stance is definitely more upright, hips not as forward, and she notes her weight has shifted more to center.

2) moved the instep buckle position more rearward, which hopefully will help hold the heels in place.

3) put a small pad of bootfitter's foam on the tongues just above the upward curve behind the instep, again for better heel hold....let me know if this spot is incorrect, but it seemed to work, as I had her click into her skis before and after, and the slight heel lifting that was happening seems gone now.

4) realigned her cuffs using the plumb bob method; interestingly this was quite a bit off, and it seems like her leg alignment has changed since she first got these boots, as it was done then by the shop; it looks like she no longer pronates nor is knock-kneed...nice!

Once we get back on snow I'll let you know the outcome. In the meantime, I look forward to hearing your comments on our measurements.

Thanks guys!
post #10 of 19

I agree with everything that has been said but wonder if we could talk a little about her forefoot width.  She is buckling the instep buckles tightly, it sounds as if tight enough to cause lack of circulation and she doesn't like the boots when they aren't buckled that tightly.  Sounds to me a little like "Can you make my boots stop hurting when I buckle them so tightly they hurt"?


If her foot is really slender it is possible she should be in a 95mm boot.



post #11 of 19
Thread Starter 

Lou, it seems she was buckling the instep tightly in order to hold her heels down.  In order to remedy that I have put the pad on the lower part of the tongue and moved the instep buckle mount point more rearward to pull the foot back (see prev. post).  As it turns out (divulged under intense interrogation from her Dad) that she was also not buckling the lower cuff buckle tightly enough either, which certainly didn't help w. the heel hold problem.  Hopefully with my modifications and some instruction about buckle tightness, she will be able to have the instep buckle looser now.  Some on-snow time will reveal much.  We're just waiting for a spell of bad weather to clear here, and we'll be out skiing again.



You raise a good point about forefoot width.  If you noted in my OP, doing a shell fit showed there is about 1/4 inch room at either side of the forefoot.  How thick and firm the liner is in this boot to take up some of that space, I'm not savvy enough to judge - maybe that's too much(?); maybe it's OK(?).  For comparison, she did a shell fit in my wife's Lange RS110's (97mm last), and she had perhaps 1/8 inch space....much better.  (The caveat being that the Lange's were one size smaller).


If I actually measured her forefoot width, would that be at all helpful? Happy to do that....just let me know how to measure (weighted vs. unweighted) and where (across the metatarsals?).


Bottom line:  if this boot is fundamentally the wrong match for her wrt. forward lean and shell size, then I would be willing to get her into a pair that is better suited.  OTOH, if we can make it work with some simple tweaks, then I'm all for it.  At very least, doing these mods to the Salomons will tell us if we are on the right track -- ie. if getting her more upright (spoiler flare out), improving heel hold (tongue pad, instep buckle), and getting knees realigned (cuff adjustment), all helps to alleviate the pain, then we know what to look for in a new boot if we choose to go that way.  But I think it's well worth going through this process to find out exactly what works and what doesn't, and then decide from there.  I do not want to run out and buy a new pair of boots, only to have this problem persist.

post #12 of 19

Personally, IK am never a fan of padding when we can use a smaller shell to begin with.  The 1/4" of space on each side of her foot is definitely too much and I might be inclined to think that in her case even 1/8 is too much although certainly better.  Many times we fit with essentially zero space then punches to accommodate bony prominences.



post #13 of 19
Thread Starter 


Hi Lou,


Doesn't the thickness and firmness of the liner have an influence on the tightness of the fit? Even assuming a thicker liner, would you say that 1/4" forefoot play is still too much?


I would be happy to measure her forefoot width, if you would tell me how to do it.  ie.  weighted/unweighted...etc.  Then perhaps you can recommend if she should go with a 98mm last or narrower.

post #14 of 19

help with math…….1/4" on each side of the foot = 1/2" of width space at the met heads ( if they line up with the widest point of the shell, which they may or may not depending if she actually buckles the boot down enough to hold the heel down and back to the shell)


1/2" in the foot is enough to get 4 mice in each boot along with your daughters feet. i know you are thinking that that is crazy, just remember the mice squish down really small and compact under pressure, so you might even be able to get 6 of the little suckers in there. mice fur is super warm as well on really cold days.:rolleyes



Edited by starthaus - 1/28/14 at 8:09pm
post #15 of 19
Thread Starter 

I will set some traps in the basement tonight.  Should be able to bag a few in the cold cellar where we keep the kitchen overflow.  Must be a mega Costco-size box of Cheerios down there that will attract them.  :p


Seriously, I can take a hint. :rolleyes   The boots are too big, which no fur padding can fix.  That seems clear now.  But at least the modifications to the Salomons will tell us if getting her more upright, with better heel hold and less instep buckle pressure will alleviate the problem.  Makes looking for a suitable match in a new boot much more focused.  I'm thinking Lange RS/RX, Tecnica Inferno....something like that, with a more upright stance and narrow heel pocket, will be a good match. Finding a good bootfitter here will be the first task.


I'll post back after some on-snow time with the boot mods and let you know if they worked.  



post #16 of 19

a good time to remind you and other readers that a ski boot in not a tool to hold your daughter or any other skier in the correct skiing position. so many times we respond to skiers on this forum that are looking for the boot to be a crutch that keeps them from being out of position or locks them into a proper skiing stance.


at best the perfect set-up of a ski boot, allows it to be an early warning system for when you begin to get out of position. from there it is completely up to the pilot as the french love to say, to adapt your COM over your feet and therefore your skis to re-center into that balanced position calmly awaiting the next signal from your well balanced early warning system of a boot.


when the boot does not properly contain the foot, all bets are off because your early warning system becomes a moving target that never allows you to relax. in fact it cause just the opposite, which increases muscle fatigue and greatly reduces the fun factor of using gravity as you friend to rip down the mountain.



post #17 of 19
Thread Starter 


Hi Jim,


Point well taken, and some very pertinent comments at that.  Just to be clear, we are not looking to get my daughter into a certain ski position, or use the boots as a crutch.  Rather, the opposite is true -- we are trying to get her out of a position that is causing her pain and discomfort.  ie. too much fwd. lean, and poor heel hold and the associated problems therewith (too much buckle tension; shell fit too large, etc.).  This appears to be a classic case of a well-intentioned but inexperienced bootfitter giving advice on this purchase, the result being a boot that is a poor match for my daughter's foot shape and skiing style.  Again, I'm sure you see this all the time on this forum.


We will be visiting some bootfitters soon looking for a replacement pair, and I will be very alert and wary of their advice.  


Lesson learned.  I am now better informed and more knowledgeable.  Grateful too, that boards like this exist to give impartial, expert advice to laypeople like me.  Keep it up.  It's not taken for granted.

post #18 of 19
Thread Starter 

A quick update here...


After the boot modifications, my daughter skied last night and today completely pain free! There was still some slight numbness and very minor swelling, but overall this is a huge improvement.  She is delighted, and so am I.  After more than a year of trying to figure this out, we finally know what caused it.


We also visited a couple of ski shops yesterday, and she tried on 7 pairs.  The objective being to find a boot that is a better shell match to her foot shape, is more upright in stance, and has better forefoot and especially better heel hold.  A less-stiff flex is needed too, it turns out.  No decisions yet, but it looks like she will be going with a Lange RX or RS model, and dropping one shell size.  Her foot size is borderline 24.0, so the bootfitters have recommended going to a 23.5 and punching/grinding where needed.  Makes sense.

post #19 of 19
Thread Starter 

A thank you is needed here to you guys, especially Jim, for getting us on the right track.  And for suggesting some modifications that made it very clear as to what the root causes of the problem were and thus avoided us making the same mistake again.


We appreciate the help.  

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