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Metatarsalgia Issues

post #1 of 8
Thread Starter 
Hello -
Help! The skier is my daughter. 19 years old, 130 pounds, 5 foot 5. A fairly narrow foot and ankle with medium to high arch. A very good skier. Has had problems with foot pain in her new boots. Here is the deal -
  • Old boots were old Nordica beginner boots - very soft. She had no issues at all other than the performance was way below her ability
  • New boots - Nordica Beast 12W with custom orthotics. Way better performance-wise. But ouch. Not right away though. Eventually very painful under the ball of her feet. Both feet. Usually, on the lift and usually after a few runs. Biggest issues were when skiing big mountains out West. Metatarsalgia was the verdict according to the guy who built her footbeds. He added pads under the metatarsals. This has helped but the issue persists although not as bad. Worse in one foot.
  • I wonder, one boot with no issues. A new boot and pain in both feet in the same place. Could the boots be wrong for her? My logic - narrow-ish feet with high arch in boots which I read have a wide foot fit. Not right away so perhaps an issue with the liner packing out. Big mountains seem to cause the issue which makes me wonder if there is room around her foot and that she is forced to grip her toes or something and does so more emphatically when on a big mountain with long hard runs?
  • What do you guys think? Perhaps a narrower fitting boot would help? Such as the new Lange Freeride 110W, the Tecnica Pro, Salomon Scarlet, or the Dalbello Krypton Storm?
Thanks! Tom A.
post #2 of 8
These type of problems can always be difficult. I it is easy to be suspicious of the new boots and that they are too high volume. Problem isn't necessarily that liners have packed but more that your daughter is overbuckling the instep buckles to keep everything tight.

Problem is it is likely that her old soft nothings were just as high volume. But in my opinion it is never wrong to fit the narrowest boot possible. It holds the foot best with minimum of foot crushing buckle tightness.

My initial thought was that it was an orthotic problem but you said the orthotics were added to resolve the issue and they helped somewhat.

If that is correct I will go back to boot issue and state that maybe some grinding on the tongue directly over the instep will help.

Would also recommend she try some low volume race boots in a good shop and see what she thinks. Dalbello Krypton series also fits in with race boot category.
post #3 of 8
I suspect that she is self stabilizing due to the high volume in the boot. The Beast has a pretty high instep volume so I'd doubt that the boot is too low in that area. The overbuckling mentioned by race510 is certainly a concern, again, this relates to too much room. I don't think making more room is the answer. Add some higher end jr race boots such as the Nordica Doberman 90 to the mix of candidates. The Dalbellos are medium volume.

post #4 of 8
just to chuck another issue into the pot, how much flexion does your daughter have at her ankles, if this is restricted then it could be that she is forcing all the weight onto the ball of the foot causing the pain. it may be something as simple as stretches for the calf muscles could resolve the issue

good luck
post #5 of 8
Thread Starter 


Lou, SJ, Colin -

Thanks much for your input. Helpful stuff.

Colin - Interesting bit about the calves. She has actually been working the calves. She is on the equestrian team at school. Flexing your ankles so the heel is lower than the toe is important in that sport so they have her doing all sorts of stretching exercises. She has also started yoga with the same general objective - overall flexibility.

We will also try on a variety of low volume race boots - including the Dobies (her Dad, me, is on Dobie 130's and she does have similar feet but thankfully not her dad's chicken legs). The trick here will be to get her to ignore fashion and go purely function!!!

If it helps I looked closely at her footbeds. Relatively hard materials, metatarsal pads on both, and the foot guy also added a little padding to the bottom of the footbed, specifically from the metatarsal pad forward. Looks like a thin layer of neoprene or some such thing.

Again thank you!

Tom A.
post #6 of 8

she is by your own admission 19 years old..... good luck on the function over fashion, glad i don't have to tell her
post #7 of 8

Dont jump

Conclusions, that is. Metatarsalgia is a medical diagnosis, only a qualified podiatrist or orthopedic MD should make. If there is no other indication of this issue in her regular street shoes, where it is PRIMARILY symptomatic, then I would be wary of any suggestion of a medical problem and therefore look more closely at the "orthotic".
To clarify, an "orthotic" is a medically prescribed, and most importantly, fabricated from a CAST MOLD of a client's foot. If the device your daughter has was not prescribed, then it is not an "orthotic"- it is a "molded insert".

In my practice, I have had this issue several times. At times, the original mold was not taken with the foot in the proper position, or the evaluation of the foot was not thorough enough leading to an uncomfortable device.

If the issue were truly metatarsalgia, I would think that a wider boot may be beneficial; by adding transverse arch support, ie. metatarsal pad, the forefoot metatarsals will be spread out relieving plantar pressure and alleviating the issue. A wider boot will allow such support and forefoot expansion.

The issue may not be her foot. I suggest a dynamic stance analysis, especially in fore and aft alignment. If she is too far forward, an excess amount of force will be directed thru the forefoot, thereby mimicking symptoms of metatarsalgia.

Ben Goldstein
post #8 of 8
Thread Starter 

Jumping only if the pediatrist says jump . . .

Hi Ben -

Thanks much for your response. Actually the guy who did my daughter's full custom footbeds originally and then modified them when the problem started is a pediatrist. Dave Cardillo in Rochester, NY. He does virtually all the good skiers including racers. Did my boots as well. He has a great reputation in the area.

Symptoms and impact of modified footbeds. The symptoms have only come up while skiing and the modified footbeds did help the problem. But while one foot is pretty much pain free the other is still a problem although tolerable according to my daughter. Note that the added padding under the forefoot section of the footbed is only under the forefoot. This has the effect of lowering the heel a bit which it seems to me should take weight off the forefoot.

Stance - Cardillo did check her stance in the boots but not with the skis which I am thinking is worth a look. I was there but don't remember any comments from Dave about her stance from which I conclude it did not look dramatically bad to either the fore or aft. The skis she was on when all the excitement occurred were Nordica Beast 69 with an integrated binding. The new sticks (yet to be on snow) are Head Sweet Fat Thangs which will get a two peice binding Salomon.

It seems a careful examination of the fit of her current boot including her stance is in order. For sure we will be back to see Cardillo as he is very good about follow-ups to ensure all is well.

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