Ver 2.0 Boot Fitting Guide

8/3/2019 Ver 2.0 Boot Fitting Guide

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Stephen A. McDonald, C. PedJackson Hole SportsBase of Bridger Gondola

1PM-Close, Tues-Sat


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Please feel confident recommending your stronger skiers, high end clients andguests to:

Stephen A. McDonald, C. PedBoard Certified PedorthistJackson Hole SportsBase of Bridger Gondola

Excellence in Custom Ski Boot Fittings

307.739.2687

Bootfit and Custom Orthotic: $ 280.00 + BootBootfit Only: $100.00/hour + Boot (doesn't happen often)Bootwork by Stephen: $100 hour/ .5 hr/min.

Contact me for Pro Price list- I'm here to help the working man.

Making you look credible to people you send my way: Priceless

Peak Season and high traffic times: 1 -2 day wait, AM appts. occasionally accepted

This information showing common ski boot problems may assist you in helping your clients...enjoy and pass the time accordingly. Good information is priceless. I hope you feel confidentsending your guests w/ boot problems to me.

Thanks! Stephen


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Heel Pain

In a medical environment heel pain is one of the most frequently seen problems forDPMs/Orthos and it's no different at the boot bench. Heel pain and skiing just seem to gotogether. Hard landings and rough conditions batter a (more) vulnerable (than you think) partof our body.

For the skier and snowboarder, heel pain will come in three flavors.

1) Plantar Fasciitis2) Heel Spur3) Fat Pad Syndrome

Remember: If you don't fit neatly into these categories see a MD/DPM/Ortho ASAP!

Plantar Fasciitis

Problem: (under the) Heel Pain, Strained Plantar Fascia, orhistory of Pantar Fasciitis. Usually this isn't the first time it hashappened. Once the Plantar Fascia gets strained, you'll likelyhave problems with it for life. Prevention is key on this one!

Who: Those with sedentary life styles are at most risk as thesudden increase in activity from a yearly ski trip causes thisubiquitous strain. Excessive pronation also is a contributingfactor. Being overweight doesnt help. In extreme skiers andthose pretending to be, a sudden strain from landing or jump

(!!!) can cause plantar fasciitis. Likely injured in park and pipe with a solid, flat landing.Found in teens and athletic 12-16 year old girls.

Solution: Heel Lift, Arch Support, Custom Orthotic, Rest, Vitamin I, Properly fit boots, seeStephen for stealthy skiing fix!

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Heel Spur: This natural occurring and necessary tuberosity (bony prominence) on the frontbottom of the calcaneus varies in length in some people. Seen in skiers and snowboarderswho continually over flex their equipment. Caused by repeated boimechanical strain on theAchilles and under-the-foot muscles/ligaments.

Simple and sometimes temporary orthotic modifications canbring a world of relief. Even though this condition is notusually acute (sudden onset), off loading the area throughorthotic management can be obtained.

Getting plantar fasciitis and heel spurs mixed up is aseriously painful experience. Proceed with caution andconfidence.


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You'd be surprised how many clinicians/bootfitters get these mixed up. Think of it this way:

Plantar Fasciitis Heel Spur

Broad dull ache Pin-point pain at front of Calcaneus

First step pain (AM) Pain all day long (AM & PM)

Pain from heel to toe Deep pain

Goes away with activity Pain worsens with activity

Torn/stressed/rupture of ligament Aggravation due to lengthened calcaneal tuberosity

Plantar Fasciitis painruns along the insideto middle of your foot,from the heel to justbefore your big toe.

Heel Spur Pain shouldfit neatly under yourthumb just in front of

the bottom of yourcalcaneus.

I'm a Snowboarder, do I need Footbeds/Orthotics?

You bet. The constant fore/aft rocking motion going heel totoe is more than most's people's arches can handle. ThePlantar Fascia, the long ligament that runs under your foot,

can be easily strained. Spending time in the park and pipewon't help either.

I've often thought every snowboarder needs a custom footbedas much or more than most skiers. Snowboarding can behard on your feet.

Each year a bigger part of my business is snowboardersgetting a custom footbed for additional control and comfort.


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Fat Pad Syndrome:

Problem: Hard landings can dislodge/shift the natural fat pad on the heel. Not always visible.Also comes from hard long hikes into the backcountry where the foot is shifting in the boot.

Who and Where: This Plantar Pain is distinctly different from a heel spur as it feels like a dullsoft bruise in the middle bottom of the heel. Remember Plantar Fasciitis and Heel Spurs aremore anterior (front) of the heel and are palpable with slight point pressure.

Seen in skiers taking long hard marches in heavy boots off the couch. The repeatedpounding of the foot in a heavy ski boot in icy bootpack steps can shift the natural fat pad thatcushions our feet. Thought to be accentuated by colder temps and thick socks increasingshear in boot.

How to Fix: Get a custom orthotic to secure the foot in the boot. Reducing volume in theboot is key as the heel shifting and banging is causing the problem. Tighten up the heel tostop the banging. This can either be done with a custom orthotic with a higher heel flange ormaybe padding the exterior heel of the ski boot liner.

Common Forefoot Pathologies

What bootfitters hear: Ball of my foot is killing me, I feel a blow touch under my foot, nailthrough middle of foot...

What it is:

Neruomas- Pinched nerve from too tight aboot.

2ndMet Overload- Boimechanical errorsfrom previous injuries can cause a secondmetatarsal overload. This especiallyoccurs where Morton's Toe is present.When the second toe is longer than thefirst one, the second metatarsal acceptsmore pressure than it should creating acallus that can be painful in a tight boot.

Metatarsalgia- general forefoot pain.Usually caused by a reduction in fat patdensity under the metatarsal heads. Youneed arch support to lessen the tripodeffect of the calcaneus, 5th met head andthe 1st met head.

Sesamoiditis- Two pea-sized bones under


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the ball of your foot can become dislodged. It is pretty painful. I see it most in strong skierswho have to take a fast turn after a big jump. Arcing giant GS turns on Gros Ventre is anothercontributing factor.

How it Happens: Large or wide feet get cramped into a narrow boot- pain ensues. It's atough call- strong skiers and snowboarders need a narrow boot for control, but the narrow

space in the forefoot pinches nerves that run between the metatarsal bones. Ouch.

Solution: Thinner sock, check for wrinkles, reinsert insert/orthotic and/or replace it. Often ashift or wrinkle in the liner/footbed causes a change in volume. A skillfully placed met pad or asmall neuroma pad will bring instant relief. Sometimes switching to a thinner sock will do thetrick.

Always think: Narrow boot, thick sock, age M/F and older women.

Goes Away: Except for sesamoiditis, usually immediately.

Medial Ankle Pain

Problem: Soreness/redness on the inside ankle.Sometimes it degenerates into bruising/blisteringand broken skin. Likely the ski boot was nevertight enough in the first place.

How it happens: Putting the boot on properly sothat the ankle is properly secured is key. Whenthe medial foot structures are continually

hammered by Jackson's steep terrain- beginnerand intermediate skiers have to deal with thisfrequent hot spot. They're not used to the boothaving to be that tight for adequate control- andthat causes trouble. Repetitive microtrauma &neurocompression (!!!) are fancy terms forbruising and pinched nerves just above themedial ankle.

Solution: This is where I look to tighten up the boot. Almost 100% of the time, a C-pad orother cut padding will help solve the problem. A custom footbed to secure foot in boot is

essential. Sometimes a varus wedge is just what the skier is looking for. Depending onindividual anatomy remove material from liner as necessary. The medial ankle is able to takeconsiderably more pressure than the top of the foot and toes and responds well to padding toreduce bang. Modern ski boots are laterally stiffer and taller than their previous counterpartsso it is important to make sure the ankle fit is SNUG.


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Anterior Shin Pain

Problem: Pain at step off or pain walking without ski boot (took it off at lunch), hurts whenskiing, can't ski, bruising, bleeding.

How it happens: Poor form or tail riding (!!!)- yeah you can't be

afraid to say it. Wrinkles in sock or pants in boots can causepressure points and muscle strains.

Sedentary lifestyle/larger frame is a risk factor.

Solution: Ski School for better form is a start. Get a thinner sock.A heel lift offers a slight change in biomechanics that will give thearea relief. Make sure thermal underwear is not in the boot- theonly thing in your boot should be your foot and a thin sock. AnEliminator Pad with a custom excavations over the problem area iskey. Often a custom pad that is thin enough to pad/off load area butnot thick enough to throw the skier into the back seat works.

Posterior Calf Pain

I think Bootfitters see this less than before. With theadvent of reverse camber and forefoot rocker skis,skiers are having an easier time staying balanced onthe ski. The posterior calf pain I see is usually acompression injury. Sure on pow days I see tailriders, but mostly it's pinching boots on a large legcausing deep muscle bruising.

Shows up as: Rear leg pain, especially where theboot tops out. Skiers and snowboarders often use theterms burning or throbbing.These leg muscles arein deep muscle compartment and bruise easily. After a good pow day, I talk with skiers whocan barely walk.

How it happens: Too much leg in boot- move the cuff ladders to get more circumference.Poor form or ability- tail riding, cankles, large calves, found in skiers with short wide feet &stocky frames, Occasionally I'll run across a strong skier that hammered the buckles for thatbig run and simply the boot boot cuff was too tight.

Solution: thinner sock, heel lift (!!!), no pants in boot, properly fit boots.


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The Cankle

Problem: Hey, this is not just a woman's issue! Wesee 'em all the time, from the very young to the veryold. To be polite, let's just say people are more chubbythan they were just a decade ago.

How it happens: Building from the above section, thisis also a compression injury. I firmly believe it takespractice (and patience) to build up the musclesrequired to distribute ski boot pressure along thekinetic chain. Some people's muscles are softeranddon't respond well to pressure in a ski boot. Being in asedentary position on office days doesn't help either.

All of this is compounded by a low tolerance for athleticpain.

Solution: Wider boot, cuff. A heel lift is required to hopefully elevate the injured area from thepinch point. Moving the upper buckles to a wider position may allow addition banging, whichcan exacerbate the issue.

Less is more from the shin down. Let the bootliner/shell/custom insert do the work. Nothing but the sockshould be in the boot.

Wool and Synthetic Sock Choice

Warmth comes from the boot, not the sock. The thinner the sock, the greater the circulation.The warmer the foot. Stay away from padded socks. Ultrathin wool (Smartwool) andsynthetic (Bridgedale) are all you should ever need with a proper boot fit. As the liner beginsto pack out, padded socks work well to reduce volume. Be careful though, the thicker sock,the more likelihood shear (friction) will be introduced.

I honestly believe more vacations get messed up because of poor sock choice. It is thegateway to all other problems in the boot.

The Angry Hard Charger

Problem: Sore shins, sore ankles, poor performance due to painfulboot. Too stiff a boot is making for a bad experience. Generally thisguy will wait until his leg is going to fall off before going to see theBootfitter.


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How it happens: Piste-Off Skier who lives in an office like veal. Big bell-to-bell days early inthe vacation have taken his body by storm.

Solution: Get a custom cut shin pad or thicker Eliminator Pad for shin bang. Takes tenminutes @ JH Sports. Your guest needs a custom footbed to secure the foot in the boot.

Explain the Ten Day Rule

You're skiing 10 days/year??? Buy Boots! You'll be happy! Without bringing comfort andperformance into the conversation, buying boots just makes financial sense. After just a few daysskiing per year, the cost of renting boots adds up.

The comfort and performance of your own boot is what is all about. You'll never get that from a rentalboot. Industry stats show that many skiers double the number of days they ski in a year after

purchasing boots.

Notes on Properly Fit Boots

Boots that are too loose are not only dangerous (lack of control), they cause strain in thekinetic chain as the skier/snowboarder overcompensates with muscle actions. Muscles inflexion as can actually pinch nerves higher up the kinetic chain. The boot is your friend. Useit that way.

Don't clench/grab with your toes. Let the footbed/orthotic do the work. The skier or

snowboarder needs to be on the arch in a comfortable position. Grabbing with your toes forextra control doesn't work. Don't do it.

Tell the skier to imagine relaxing the foot. The boot needs to be tight enough to relax the foot-but not cramp or push with point pressure. It's a tough sell, selling the boot a touch tight- sothat when the liner compacts it won't be too big! A custom orthotic greatly helps with thisprocess as it secures your foot in an accurate position during the break in process. VeryImportant

Cold Feet

There is a direct correlation between dehydration and cold extremities (particularly feet)!!!Drink the water!!!

Underling conditions such as Raynaud's Disease can cause cold feet. Boot heaters, likeHotronic and Thermic, help but can add extra weight to your set up. Get don't get bootheaters unless you have to.


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Frequently a good skier/rider will come to me with foot pain. The boot work from home lookssolid, the equipment is nice. Dehydration creeps up on Jackson Hole enthusiasts because ofour dry environment. Muscle fatigue follows shortly there after. Encourage your guests todrink plenty of fluids. Also,drink good wine after skiing. But not too much- alcohol dries youout.

The $50 Boot Tune Up: Every skier needs a $50 Tune Up! It should be at the start of everyvacation. Just a few simple steps will make your feet feel great. A little nip here, a little tuckthere can change your guests' vacation. Recommend it- and come get one for your boots.


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Gender Specific Fitting Issues

Chronic Posterior Tibial Tendinitis- due to excessivepronation often seen in women's feet. Increasing weaknessin the primary inverter in the foot. Shows up as a duck-

footed over pronated stance.

The incidence of bunions always has been reported assignificantly higher in women versus men, with theimplication that woman's shoes have a slow deforming effecton the forefoot. In this town I see as many bunions on menas in women.

Stress Fractures- Lower bone density and potentially lowercalcium intake compared with male athletes also may make the female athlete moresusceptible to stress fracture.

Forefoot & Met Issues: Women have wider a wider forefoot, plan on issues with strongerwomen who want a tight boot. Met pad in addition to custom orthotic is key.

Also: Lower insertion point for Gastroc/Soleus complex means every woman's boot fit startswith a heel lift.

No cankle? Slender leg? No bulging calf? Narrow ankle? Narrow Forefoot?

Go right to the Men's wall and pick appropriate flex and foot shape.

Hyperhydrosis

Some people sweat a lot. Be prepared to educate the guest they will need to pay attention tothis. Feet have 250K seat glands and

Solid skiers have extra liners & know frequently changing socks is key. A second set of linerson a ski vacation is invaluable. Changing socks at lunch is a ski trip saver!

A warm foot is a dry foot. A dry foot is a happy foot.

Look for sweat related pathologies- stank, white soft and/or peeling skin, discolored toe nails,blistering,seen in mountaineers and skinners.

Hey Bro' Homeslice: Just washing your feet in the shower with soap can help control thisissue. Foot stank chases the ladiesAWAY!

Nervousness or excitement can exacerbate the situation for many sufferers.


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General Notesfrom

Sport Legs work- ask @ JH Sports base of Gondola. Cyclist have sworn by them for years. Thisnatural supplement helps your body with lactic acid burn. It works. Try some and recommend them toyou your guests. They'll go out of their way to thank you for it.

Stephen and JH Sports Bootfitters will make a footbed for any boot, $150.00- $300.00 will save yourguest's vacation.

Beginners: Calf fit is better than foot fit. Experts: Foot Fit is better than calf fit.

Many boot problems are solved by the $50 punch or grind/$50 Boot Tune Up

For the Kids: Happy is better than fit. JH Sports has Junior Lange Boots in a variety of flexes.

-Take frequent breaks and eat all day long.


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Documents

Ver 2.0 Boot Fitting Guide