Ski Boot Orthotics: Plowing Through The Options

Clinical Editor: Howard Dananberg, DPM

As December arrives, patients who enjoy winter sports begin to think about skiing. Ski boot technology has come a long way in recent years, with many comfort features added to complement the performance the boots are designed to provide. Patients will often ask your opinion as to what they need and how they can enhance their skiing. With this in mind, our expert panelists offer their opinions. Q: What are the most interesting advances now available in ski boots for the upcoming season? A: In the past five years, ski boots have moved in a few directions, according to Ben Wax, CPed. They have become more anatomically designed, providing better fit, which in turn gives skiers better performance and circulation. “Most mid- to high-level boots have a thermal molding liner,” notes Wax. “The liners are heated up and the foam in them expands. The skiers then put their boots on and the liner sets around their feet.” He notes this is a comfort feature and is not a performance enhancement like a foam-injected liner. While custom fit liners are expensive, Michael Schneider, DPM, says they will help accommodate structural problems. He emphasizes “adjustments for bony prominences early on.” Dr. Schneider says he encourages his patients to seek out an experienced boot fitter who is familiar with foot types and boot lasts. Wax says ski boots have become softer and the key is providing skiers with boots they can flex. He points out that the style of skiing is changing with the new shape of ski design and skiers must have forward flex in their boots to steer and balance on their skis while they are accelerating. He says if a boot is too stiff, skiers will constantly be sitting on the back of their skis and losing control. Indeed, Wax says the days of DPMs considering only the stiffest boots for skiing are gone. Wax mentions the new “Soft Boots” by Rossignol, Nordica, Salomon and Dolomite. He says they’re “very soft and comfortable,” although the jury is still out on their performance level. Still, he says they’re probably the best option for novice and intermediate skiers. “You cannot put a low intermediate who skis 15 days a year into an all mountain high performance boot,” says Wax. “They will not have fun. And that is what it is all about.” Women’s ski boots have been given major attention in the past five years, observes Wax. He says these boots are designed to accommodate skiers with narrower heels and higher insteps. Specifically, he notes the upper cuffs of the boots are lower to accommodate the shorter Achilles tendon and lower calf muscles that many women have. He adds that women’s boots are also softer in flex than their male counterparts. Dr. Schneider prescribes his Snowthotic device for all “on snow” sports including alpine, Nordic Telemark skiing along with snowboarding. He says the Snowthotic “is the most precise method of bringing the ground up to the foot which, in my experience, has allowed my patients to have more control with less effort.” Dr. Schneider says since there is no heel-toe dynamic in skiing, his device locks the foot into “neutral” position by using extrinsic rearfoot and forefoot posts along with other modifications of the device. Doing so converts the boot/Snowthotic/foot into an integrated system that responds to action from above, according to Dr. Schneider. Q: Under what conditions would an orthotic be advisable as opposed to canting of the outside of the boot? A: Howard Dananberg, DPM, says that as a general rule, you should manage any deforming component of the legs (i.e. genu varum or valgum) with an external cant on the outer or inner edge of the boot. “Canting outside the boot is a great tool to give the skier a level playing field,” says Wax. Since skiers use both the inside and outside of their skis, Wax says they closely distribute weight to both. As skiers roll their knees across the axis of the ski, they will be transitioning from the medial edge of one ski with the lateral edge of the other ski to the opposite edges, ideally at the same time, notes Wax. He says canting brings the timing of the transition for each leg as close as possible. As for cost considerations, Wax notes canting outside the boot costs about $100 for plates which are added under the bindings. Doing that creates a left and a right ski.

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