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Some alignment advice and help needed

post #1 of 9
Thread Starter 
Need help with the following:

1)have severe pronation right foot, pronated left foot also, but not as bad as right
2) knockneed and bowlegged( tibia's curve in both legs - knees are knocked, ankle bones protrude inside
3) narrow heel - wide forefoot
4) medium to high arch - can place place three fingers under arch, barely touching top of arch about 2 inch into arch, before I hit end of arch gap
5) thin ankles,above protruding ankle bones( I can almost span my ankle with my thumb and forefinger - tapering up somewhat to normal near calf
5) 4 1/2 degree plane on right foot of doberman p130's, no cant or plane on left boot
6) 6 '1", 34 in inseam 200 lbs
7) fitted many, many times for orthotics/alginment - by many experts from Vermont Utah, Pa, Colorado - modest success if any at all
8) ankles seem to be never stablized, can rotate right knee about 60 % degrees while in oththotic without lifting heel and foot firmly on floor - no matter who makes it. left knee same problem but to a lesser degree. Can also have ankle move inside
9) While in orthotic, right knee is situated inside of big toe, left knee seems ok.
10) slight back pain pressure, on side of right pelvis and in back of plevis near right side of back when done skiing.( like a small round spot)
11) needed heel lifts to make up for inflexible achilles tendon or limited dorsiflexion
12) have minimal inside edge hold on either ski - skiing reverts to inclination to get edge hold. both skis never ride flat
13) level 8-9 skier - never raced for obvious reasons - can ski the whole mountain

Alginment tries:
cuff cant - plug fitted with material to the inside of boot liner cuff on both boots to take up space of tibia curvature and provide cuff cant
orthotic - made while standing and also without weight bearing. Doesn't seem to matter - all of them feel the same
duct tape under binding - boot interface to try right canting angles above the 4 1/2 degrees I have now. Obviously, I felt anything more than a total of 6 degrees was not acceptable

self - made adjustments - found that if I put an 1/8 inch thick shim about 1 inch wide and followed the inside edge contour of the orthotic bottom and placed that inside the boot liner( a cant inside the boot liner), then used GEL material( from Dr Scholls) about 1/2 wide along the arch on the topside of the orthotic, my knee would become aligned properly over middle between the 1 or second toe and my arch would hold without collapsing through the turn. The ankle was stabilized and I could not rotate the knee at all while in the orthotic. but excessive material added to orthotic gave some boot pain over the second/third buckle of the boot because it was too thick

Summary - topside gel material along arch of orthotic prevented arch from collapsing
- inside the boot Cant under the orthotic seemed to stablize the ankle and knee from rotating and put the knee over the 1st /second toe

Trying to do this correction with Cant's only did not work, nor did building up the arch of the orthotic alone.

Then I went to work on the knee/hip alignment, by using duct tape strips under the boot soles - but found these Cant adjustments made the binding unsafe.

Also found that placing a homemade GEL shim( made from GEL heel pads from the drug store - I had to shape them) inside the boot tongue( similiar to an eliminator tongue), tightened up the fit, such that for first time in my life, the boot hugged both my ankle and my shin. The GEL material prevented shin bang and worked, the eliminator did seem to work for me as it was too thick at the top of the cuff, and too narrow at the ankle, even with cutting it and only using bottom 1/2.

Given the above and having some success with the above but not totally satisified, what can I tell the next bootfitter to get these mods done more less professionally? Is there anything else you would recommend or that I might try? A technical description of my foot/alginment problems would be most helpful.

Any help would be appreciated.
post #2 of 9
Whew.... I don't even know where to start.

I take paypal
post #3 of 9
Have you been checked for forefoot varus / instability?
post #4 of 9
Thread Starter 
Thanks Dave:
You are a master - forefoot varus seems to be a problem
Standing on tippy toes and one foot(bare feet), I tend to tip to the little toe side with instability. doing it in the orthotic, fore balance not there. Can't raise on toes and go straight up, without pitching to the side.
I already have a varus wedge post on both feet in the orthotic - one is pretty thick( right foot). Left foot is smaller not so big a wedge. Placement of small 1/8 thick cork material of about 2 x2 inch under the orthotic, somewhere just ahead behind the big toe interface and a 1 metatasil seems to stabilize the ankle and I can't rotate the leg anymore. But it is a very precise placement, just moving it slightly forward or toward the heel( by a few millimeters) or placing too much material under the 1 metatarsil side under the orthotic, re -introduces the problem. I will seek the help of an experienced bootfitter, now that I can show him the problem and what remedies it. I wish you were on the east coast. In the mean time, I will try to adjust for it. There aren't that many good experienced fitters in PA - there is one that I know of and I've tried to contact him for an appointment.
BTW - I'm impressed that you diagnosed that from my description. You seem to listen to the customer. I have faith that you'd fix my problem - its too bad that I can't swing a trip to Telluride.
Thanks again for putting me on the right track
post #5 of 9

A couple thoughts in some degree of order :

1) If you have a measured forefoot varus, it's a good rule of thumb to correct for 1/2 to 2/3 of the 'deformity'. The forefoot - especially in a ski boot - won't tolerate a full correction.

2) Forefoot varus 'unlocks' the foot by creating a corresponding amount of rearfoot pronation to compensate and allow the foot to find the ground. Even if you partially correct the forefoot varus, you may need to provide some rearfoot support too. Posting angles underneath the forefoot and heel are key, but given your described arch profile and demands of skiing, I would avoid having any significant material under the arch.

3) There is some degree of 'acquired' forefoot varus as a result of forcing the feet into parallel position. This may worsen your situation and it may be reasonable to consider a toe out boot (more on that later).

4) Any foot deformities will get translated to the knee through the subtalar joint (think of it as a transmission that links foot pronation with leg internal rotation and supination with external rotation). The amount of transmission varies from person to person and from static to dynamic. Take home message: changes underfoot can have pretty subtle effects at the knee.

5) You will probably require some degree of underboot canting but should seek to minimize a huge correction by careful attention to accurate footbed posting, cuff alignment, and boot choice.

6) Boot last, cuff hinge axis, cuff alignment, and relative toe out can have big effects on canting requirements. Hence, it's important to try different boots on (with your properly posted footbeds) and have them measured re. canting before you decide on bootsole grinding angles.

7) If you're quite knock kneed, it's uncertain over the internet whether this is more 'bottom up' (pronation) or 'top down' (long bone torsion, knee joint angles). However, it may be reasonable to test a toed out boot to help 'unwind' you and change the direction of knee tracking. Keep in mind that all toe out boots are not equal, either in terms of degree or axis of rotation (ie. Fischer = midfoot, Nordica = heel).

There are many variables you can adjust - IMO try to find the boot that minimizes the amount of further correction that is needed.

Hope that helps (I had more time to think about your post ).
post #6 of 9
Thread Starter 
Thanks Jdistefa:

I did remove the long inside shim from the boot liner.

The Varus Wedge in the right foot orthotic seems to be high, and tapers off toward the arch/subtalar in more or less a warped teardrop shape. The teardrop shaped taper gets thinner as it approaches nearer to the tibia protrusion/subtalar. There appears to a post on the heel on the fibula side. A very slight valley under the arch/subtalar/tibia - between heel post and Varus wedge taper What I did was increase the thickness of Varus wedge as far from the tibia/subtalar under arch by duct taping a 1/8 inch thick trapezoid cork cutout. it filled the void valley under the arch some and made the varus taper less pronounced. That seemed to lockdown the heel and prevent the leg from rotating.

I do have a heel lift in the boot, and I will see how that affects pronation. I'm skiing tomorrow - I'll let you know how it works out .

BTW - I'm curious about the duck toe boot designs. Why wouldn't this arrangement cause the ski to travel away from the intended direction of the turn, instead it seems to enhance the turn shape.

I do know now how a truly corrected ankle should behave in an orthotic. I can wiggle it ever so slightly without pronation - bottom of foot seems locked solid at heel and knee can not rotate. center of kneecap is firmly dead center between 1st and second toe( not big toe) . but again an on -snow test will tell. knock- knees are not that pronounced, probably due the curved tibias, and straight femurs

Thanks for the advice and analysis.

post #7 of 9
Thread Starter 
If you are wondering - the heel lift is in the shell (on bootboard under liner,) on both boots
post #8 of 9

One of the theories with toe out boots is that they allow the foot/leg to be in a more natural position re. decreasing the internal rotation ('windup') required in the hip to stand purely parallel.

It is interesting to note that most world cup men (after testing) are in 0 to 2 degree boots. I'm not aware of anyone skiing bigger angles that 2 (anyone else chime in here ) which may say something about potential power/leverage loss and/or screwed up alignment at bigger toe out angles.

Depending on your individual biomechanics, a toed-out boot may help to engage the edge at the top of the arc, but in your case I'm suggesting it as a way to decrease knee 'thrust' to the inside. Again, hard to tell without seeing you ski, so just a thought re. testing different canting angles inside.
post #9 of 9
Thread Starter 
Jdistefa - Some experiments - this weekend.

I did manage to completely stablize the ankle - by extending the Varus wedge under the both orthotics as described above. I could also, add to heel posting and heel wedge lift without any noticeable destablization of the ankle - a real breakthru. Previously without the Varus wedge augmentation, this action has caused noticable increased pronation effects. I did experiment with heel wedge height and amount of heel pronation.

What a difference in my skiing - incredible. Skis seem to bite almost evenly. Felt very edge stable. Tried one -legged skiing. Outside edge as usual felt very stable, and inside edge felt better, could change edges via steering vs upunweighting As I added more heel lift, found the inside edge turn on one ski ( which should have been the more comfortable, removing some balance I felt before) Seemed to ski one -footed better without a higher heel lift.

Ok - so now I beleive I have my ankle stablized and it certainly imp[roved my skiing

As you predicted - fixing the Varus forefoot added more pronation to the heel. Tried to fix heel pronation by adding yet another 1/8 inch heel wedge to the inside heel area and it fixed it some, but the right ski wanted to wedge slighlty from parallel

Also when skiing bumps, felt in the back seat. Could this be due to heel litfs? I didn't take then out, but added to the them. Ski felt easier to initiated ski turn, but thru belly , still somewhat in the backseat. I'm good enough skier to compensate for that, but ion some turns, I really had to push my feet forward, when I didn't want to.

I removed the back spoiler , but this seemed to worsen the fit.

What do you think about removing the heel wedges on the boot board? The higher the heel lift wedge, the better the fit seemed.

1) but again is it a matter of finding the right height for the heel wedge? Is this what is putting me back?

Abducted - boots - I think you are right - when I tested the foot rotation with more duck footed, it seemed to not rotate as much.

Which Boots do you think would be better? I'm thinking the fischers, narrow last 98 mm - recreational race boot.

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