ankle joint








A recent post on The Foot Collective FaceBook page titled Humans aren’t meant to walk on ramps!, highlighted the problems caused by elevating the heel above the forefoot known in the footwear industry as drop. Like the author of the post, I also wear zero drop shoes like Xero and Lems exclusively  (with NABOSO insoles) and spend all of my time indoors barefoot. Like the author, I too have experienced an immediate, unnatural and a sense of disorientation in terms of a connection with the ground, when I have worn dress shoes and winter boots with moderate drop.

While some amount of boot board ramp angle or zeppa appears to necessary for a strong, tensioned stance (what I refer to as a planted or rooted stance), the amount of zeppa is turning to be much less than I originally thought. It may be less than 1.5 degrees total (zeppa + delta). Assuming zero delta, there appears to be a very narrow range within which zeppa is optimal after which a tipping point is reached in terms of adverse effects on the motor control and balance systems.

It has also become apparent that some racers are tuning ski response by adjusting binding delta. Zeppa and delta each have a different effect on ski response especially edge control and the ability of a skier to resist the forces acting on them in the load phase of a turn. I will discuss issue this in a future post.

Humans aren’t meant to walk on ramps!

Powerful post by TFC Educator @optimize.physiotherapy
Why do most shoes have a heel on them?
This really hit home the other day when I put on my winter boots (because it snows in November in Canada). Being someone who goes barefoot all day at work and at home (and wears zero drop shoes), it was a very unnatural feeling. It really threw my walking off, and I noticed the effects immediately. It changed the way I walked, stood, and made me use different muscles.
Humans are meant to have a flat base. No other animal wears mini ramps on their feet, but we do. The problem is that your body adapts to having a heel on, and it works different from a biomechanical perspective in any given movement pattern (the higher the heel, the worse the effect…but even most casual, running, and gym shoes have heels)

One thing it really does is affect your ankle/foot function. It has a huge effect on ankle ROM and tissue tension around the ankle. The problem is, when you wear a heel all day at work/at the gym/walking around, your tissues adaptively shorten and you don’t require as much ankle ROM. But then you take your shoes off and walk, go up your stairs, squat down to get things around the house etc. This is where people have issues. Not only at the foot/ankle but all the way upstream at other joints

Ankle ROM is incredibly important, and walking on a ramped surface all the time is incredibly unnatural. So do yourself a favour and spend less time in heeled footwear or get rid of it altogether

The Foot Collective is a group of Canadian physical therapists on a mission to help humans reclaim strong, functional and painfree feet through foot health education.

The Foot Collective are empowering people with the knowledge they need protect their feet from the dangers of modern footwear and the guidance to fix their own feet.


A recently published study on foot pressure data acquired during skiing (1.) recognized that compressive force pressure data acquired in skiing is underestimated by 21% to 54% compared to pressure data acquired on a force platform in a controlled environment.  The underestimation varies depending on the phase of the turn, the skier’s skill level, the pitch of the slope and the skiing mode. The paper states that other studies have stated that this underestimation originates from a significant part of the force actually being transferred through the ski boot’s cuff (to the ski). As a result, the CoP trajectory also tends to be underestimated along both the anterior-posterior (A-P) and medial-lateral (M-L) axes compared to force platforms.

In conclusion, these studies have highlighted a major contribution of different factors to the nGRF applied throughout a turn, such as the foot’s position during a turn (inside vs. outside), the CoP A-P (front to back) displacement, or precise loading of different foot sole regions.  Unfortunately, these results have been studied separately.

There is a lack of continuity across the various positions in skiing and, in particular, a lack of a model with which to explain mechanisms such as balance on the outside ski and open and closed chain internal rotation of the leg and foot in conjunction with progressive inclination and G force loading on it as the skier crosses the fall line in the bottom of a turn. The associated mechanics and biomechanics represent a new paradigm requiring new thinking and new insights. Existing text-book explanations are not sufficient to explain these mechanisms.

Open Chain Whole Leg Rotation vs. Closed Chain Rotation

Rotation of an unloaded (non-weight bearing) lower limb is relatively straight forward when there is a small angle at the knee. As resistance to rotation of the foot is progressively introduced with increasing weight imposed on it, the kinetic chain begins to close. As it closes, the points at which the foot transfers torque to the walls of rigid shell footwear such as ice skates and ski boots starts to emerge as an issue as does the loading of the foot created by the weight of the body imposed on it and the position of COM in relation to the foot.

In order to tension the biokinetic chain and trigger the two-phase Second Rocker, COM must be aligned over the foot as shown in the grahic below.  This alignment requires that the leg adduct (move towards the center of the body) approximately 6.5 degrees. To bring the 3 points of the tripod of the foot into contact with the ground, the foot must evert (sole turn outward) the same amount. Eversion is accompanied by a corresponding torque coupled 6.5 degrees of internal rotation of the leg as shown in the left hand figure in the graphic below (see my post – OUTSIDE SKI BALANCE BASICS: STEP-BY-STEP). The bipedal figure on the right shows adduction, eversion and internal rotation as 0.0 – 0.0 – 0.0 for reference. The monopedal figure on the left shows the changes in adduction, eversion and internal rotation as 6.5 – 6.5 – 6.5.


The alignment of COM with the foot can be achieved by moving COM laterally as shown by the arrow emanating from COM in the Monopedal figure or by moving the foot medially as shown by the white arrow or through a combination of the two movements.  The act of positioning COM over the outside foot (Getting Over It), sets in motion internal rotation of the outside leg and eversion of foot into the turn. This engages an over-centre mechanism between the platform of the ski and the inside edge underfoot.

The over-centre mechanism results in an alignment of the resultant force R forming an angle with the transverse aspect of base of the ski that is slightly less than 90 degrees. In order to Get (COM) Over It (the foot), it is essential that the outside leg is not only able to adduct and rotate internally as the foot everts, but to achieve this configuration without delay in order to set up the over-center mechanism. The problem for the majority of skiers is that the objective of most boot fit systems and boot-fitting procedures is to support the foot in a neutral configuration. Eversion of the foot is a component of pronation. Impeding or preventing pronation, restricts or even prevents the required amount of eversion.

Closing the Kinetic Chain on Whole Leg Rotation

Open kinetic chain leg/foot rotation with the foot unloaded (not bearing weight) is relatively simple. But the mechanics and biomechanics begin to get complicated when resistance is progressively introduced that starts to close the kinetic chain as happens when the outside ski is rotated across the path of the skier in the fall line in the bottom of a turn.
The graphic below shows a foot supported on a platform with 2 points of resistance (FR) applied to the platform opposite the 2 points of application of the moments of force, ML (green) and MM (red). The forces tangent to the arc of the moments of rotation are shown as FT.
When the weight of the body is progressively shifted to one foot (i.e. Monopedal Stance) and the foot everts, the talus (shown in gray in the graphic above) moves inward towards the center of the body and shifts slightly rearward as evidenced by the corresponding movement of the inside ankle bone.  This is easily seen when moving from bipedal to monopedal stance on a hard, flat surface while barefoot. In order to effectively transfer torque from the foot to the platform, the forefoot and ankle and knee joints must be fascially tensioned. This requires that the big toe (Hallux) be aligned on the anatomical axis (dashed line) and the forefoot fully splayed. This stabilizes the heel and head of the 1st metatarsal (ball of the foot).  Torque from internal rotation of the leg will be transferred to two discrete points adjacent the Load Counters mounted on the resistance platform.

Removing the resistance force FR from the inner (big toe) aspect of the platform provides insights to what I refer to as the Turntable Effect that is associated with internal rotation of the leg and eversion of the foot that creates an over-center mechanism. The turntable rotation is shown in light yellow. The effect will vary for different structures of the foot depending on the location of the center of rotation of the platform under the foot.

The location of the blade of an ice skate on the anatomical center of the foot has been used to explain why it is easier to cut into a hard ice surface with a skate compared to the edges of a ski. But the real reason it is easier is because ice skaters use the Second Rocker, Over-Center, Turn Table Mechanisms as shown in the graphic below. The skate is positioned under COM. It can be readily seen that the skater is not using the inner aspect of the shaft of the skate to hold the skate on edge.

In my next post, I will discuss the progress of emerging CARV and NABOSO technologies after which I will continue with my discussion of the Mechanics of Balance on the Outside Ski.

  1. Influence of slope steepness, foot position and turn phase on plantar pressure distribution during giant slalom alpine ski racing: Published: May 4, 2017  – Thomas Falda-Buscaiot, Frédérique Hintzy, Patrice Rougier, Patrick Lacouture, Nicolas Coulmy


In this post, I am going to discuss the process I follow to assess what I call the essential foot to shell clearances. This is a 2-step process.

Step 1 – Establish the clearances between the structures of the foot and the inner wall of the boot shell required for the foot to function.

Step 2 – Establish the physical connections between discrete restraint force transfer areas of the foot and the inner walls of the boot shell required for the effective force transfer to the ski, for containment of the foot required to support the processes of balance and for the coupling of the foot to specific mechanical references in the boot shell related to the running surface of the ski.

As a prelude to discussing shell fit, it is necessary to point out that a major shift is occuring in the area of focus on the human foot.

Until recently, most discussions on the human foot have focussed almost exclusively on the rearfoot; the ankle complex, the tibial-talar and sub-talar joints, ankle dorsiflexion and plantarflexion, ankle mobility, inversion, eversion, etc. This limited focus has been at the expense of an appreciation and understanding of the role of the forefoot and the complex lever mechanism that enables the first MTP joint to apply large forces to the ground. A study (1) published in 2004 commented:

The plantar aponeurosis (plantar fascia) is known to be a major contributor to arch support, but its role in transferring Achilles tendon loads to the forefoot remains poorly understood.

 Fascia is a sheet or band of fibrous tissue such as lies deep to the skin or invests muscles or various body organs.

The most plausible reason why the role of the  plantar aponeurosis in transferring Achilles tendon loads to the forefoot is poorly understood is that it has not been given much attention until recently.  

The above cited study concluded:

Plantar aponeurosis forces gradually increased during stance and peaked in late stance.

The almost exclusive focus of attention on the rearfoot has led to assumptions about the function of the foot as a system which are only now being called into question and found to be erroneous or invalid. One result is the erroneous assumption that the arch of the human foot is weak and collapses under the weight of the body. This has spawned a lucrative market for custom made arch supports intended to provide what is perceived as needed support for the arch of the foot.

In boot-fitting, the process of fascial tensioning, in which the height of the arch decreases and the forefoot splays, has been misinterpreted as an indication of a collapsing (implied failure) of the arch due to its inability to support the weight of the superincumbent body during skiing maneuvers. This has led to an almost universal perception and acceptance in skiing of custom arch supports as essential foundations for the foot and the most important part of a ski boot.

The Fascial Tension/SR Stance Connection

Plantar aponeurosis forces peak in late stance in the process of fascial tensioning where they act to maximally stiffen the foot in preparation for the application of propulsive force to the ground. When fascial tensioning of the plantar aponeurosis peaks, forward rotation of the shank is arrested by isometric contraction of the Achilles tendon. This is the shank angle associated with the SR Stance.

Immobilize – Support – Stabilize

Discussions of foot function in the context of the foot to shell clearances necessary for foot function and especially fascial tensioning, tend to be obscured by a consistent, persistent narrative in the ski industry spanning decades that the foot should be supported, stabilized and immobilized in a ski boot. Foot splay, associated with fascial arch tensioning, is viewed as a bad thing. Efforts are made to prevent foot splay with arch supports and custom formed liners in order to the fit the foot in the smallest possible boot size in the name of optimizing support.

In the new paradigm that exists today, the foot is increasingly viewed in the context of a deeply-rooted structure. In the design and fabrication of footwear, attention is now being directed to the accommodation of the  fascial architecture  and the importance of fascial tensioning as it pertains to the science of the human lever mechanism of the foot.

Fascial Tensioning and the Human Foot Lever

Fascial tensioning is critical to the stiffening of the foot for effective force transmission and to foot to core sequencing.

The body perceives impact forces that tend to disturb equilibrium as vibrations. It damps vibration by creating fascial tension in the arches of the foot and the lower limb. Supporting the structures of the foot, especially the arch, diminishes both the degree and speed of fascial tensioning to the detriment of the processes of balance and the ability to protect the tissues of the lower limbs through the process of damping of impact forces.

Dr. Emily Splichal has an excellent webinar on The Science of the Human Lever – Internal Fascial Architecture of the Foot as it pertains to foot to core sequencing –

The DIN Standard is Not a Foot Standard

A major problem for the human foot in a ski boot is the DIN standard toe shape. DIN stands for ‘Deutsches Institut für Normung’ which means ‘German Institute of Standardization’.

The DIN toe shape creates a standard interface for bindings. In a strong, healthy foot, the big toe or hallux should be aligned straight ahead on the center axis of the boot/ski. But as an interface for the human foot, the DIN standard toe shape of a ski boot is the equivalent of a round hole for a wedge-shaped peg.

The graphic below shows a photograph of a foot overlaid over a photograph of the ski boot for the same foot. The outline of the wall of the boot is shown in red. Even though the length of the boot shell is greater than the length of the foot, the big toe will be bent inward by the wall of the shell using the one finger space behind the heel shell length check.


The Importance of Foot Splay

The progressive fascial tensioning that occurs as CoM advances over the foot transforms foot into a rigid lever that enables the plantar foot to apply force the ground or to a structure underneath the plantar foot such as a ski or skate blade. Forefoot splay is important to the stiffening of the forefoot required for effective plantar to ground force transfer.

Ski boot performance is typically equated with shell last width. Performance boots are classified as narrow. Such boots typically have lasts ranging from 96 mm to 99 mm. Narrow boots are claimed to provide superior sensitivity and quick response, implying superior control of the ski.

The outside bone-to-bone width shown in the photo below is not quite 109 mm. The boot shell has been expanded. The 2 red arrows show the 5th and 1st toe joints (metatarsophalangeal joint or MTP joint). A prime hot spot in less than adequate shell width in the forefoot, is the 5th MTP joint. Even a minimal liner will narrow the boot shell width by 3 to 4 mm.


Shell Check: Start Point 

I start with a skier standing in both boot shells with the insole in place from the liner then have them claw each foot forward in the shells using their toes until they can just feel the wall of the shell with the outside (medial) aspect of the big toe when they wiggle the toe up and down. If there is a finger space behind the heel, the shell is in the ball park.

A second check is made with the skier standing on one foot. Some allowance for the correct alignment of the big toe  can be made by grinding the inside of the shell where it is forcing the big toe inward. When fully weighted, a fascially tensioned forefoot will splay approximately 3 mm for a female and 5 mm for a male.  The ball shaped protrusion of the 5th MTP joint is typically almost directly below the toe buckle of a 4 – buckle boot.

Once a skier can stand on one foot in each shell with adequate space for normal foot splay, the rear foot can be checked for clearance. The usual sources of problems are the inside ankle bone (medial malleolus) and the navicular and/or the medial tarsal bone. A good way to locate the prime areas of contact is to apply a thick face cream or even toothpaste to the inside ankle bones then carefully insert the foot into the boot shell, stand on it to make contact with the shell, then carefully remove the foot. The cream will leave tell tale smears on the boot shell which can then be marked with a felt pen.

Getting Step 1 successfully completed can involve alternating back and forth between forefoot and rearfoot clearance. Until, both areas are right, full normal foot splay may not occur. Step 2 is done in conjunction with liner modifications which can be a process in itself and is often the most problematic aspect of creating an environment in a ski boot that accommodates and supports foot function especially fascial tensioning.

  1. Dynamic loading of the plantar aponeurosis in walking – Erdemir A1, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA  – J Bone Joint Surg Am. 2004 Mar;86-A(3):546-52.


The lack of proper technique seem so often is not due to a lack of ability, but to an unsatisfactory functional configuration of the shaft in so many ski boots.

–  Sports Medical Criteria of the Alpine Ski Boot – W Hauser P. Schaff, Technical Surveillance Association, Munich, West Germany – The Shoe in Sport (1989) – published in German in 1987 as Der Schuh Im Sport – ISNB 0-8151-7814-X

In a conventional ski boot, the rear aspect and sides of the shaft are fixed in relation to the shell lower with the result that the angle of the rear spine of the shaft is fixed. The leading edges on either side of the shaft, overlap at the forward aspect where they are drawn together by closure means. In this configuration, the angle of the shank of a user is dependent on the degree with which the closures draw the uppermost forward aspect of the leading edges of the shaft towards each other, and towards the rear spine, in proportion to the amount of overlap created by the operation of the closure mechanism.

The graphic below shows two photos of a right ski boot shell. In the left photo, the shaft buckles are operated to the minimal closure position. In the right photo, the shaft buckles are operated to the maximal closure position. A red reference line at the rear spine indicates the fixed shaft angle. A red reference line at the front aspect of the shaft overlap indicates the variable aspect of the shaft angle is it pertains to the shank angle of the user. An arbitrary reference center with which to gauge the variance in the shank angle is shown in black. The reference shank angle in the maximal closure position (right boot) is 8 degrees less than the reference shank angle in the minimal closure position (left boot). In terms of angles of ankle flexion, the ankle of the same foot and leg in the boot shell in the right photo would be 8 degrees plantarflexed when compared to the ankle of the same foot and leg in boot shell in the left photo.

Shank difference

The implications of this arrangement are that the shank angle of the user will change in response to changes in the operation of the closures of the shaft, especially changes in the top shaft closure and/or the amount of tension in the power strap, if equipped with one. For the most part, racers are unaware of the critical nature of the correct shank angle. They have erroneously assumed, or have been taught, that a securely tightened shaft is essential for good control of the ski. The tighter the shaft is secured to the leg, the better the control. As shown in the photo below, boot makers provide shaft buckles with high leverage features that facilitate a secure closure of the shaft with the leg. Closing the boot shaft beyond the shank reference angle can have serious implications for balance and control of the ski.

Leverage boost

The angle of the shank of the user is dependent on the degree of overlap of the leading edges of the shaft, including the tension of any power strap. The cross-sectional area of the leg of the user at the boot top, in particular, the front to back dimension of the cross-sectional area, is also a factor that affects the correct angle of the shank.

The two photos below compare the shaft angle of a stock boot shell to the shaft angle of a boot shell that has been modified to reduce the shaft angle by 8 degrees in order to correct for excessive shank angle.

8 degree difference

Operating the closure mechanism of a shaft beyond a certain point creates another problem, as shown in the photo below, deformation of the interfaces of the overlap elements of the shaft.

Overlap deformation

The angle of the shank of a racer is critical. It must be maintained within a narrow range for optimal performance. Anything that has the potential to alter an optimal shank ankle should be carefully evaluated.

Related post: GETTING SHAFTED BY THE (SKI BOOT) SHAFT -…ski-boot-shaft/




The first thing I look for in a ski boot I am considering is a shaft with sufficient stiffness to create a defined oval shape that will accommodate 14-15 degrees of lead segment low resistance ankle flexion before firm contact of my shank with the front of the shaft occurs. Because my shank is free to move fore and aft up to 14-15 degrees within the shaft, I tend to be acutely aware of what the tongue is doing on my shin. This is much harder to sense in boots with flexible shaft overlap segments that won’t assume a defined shape and especially in a boot with the shaft buckles and power strap cinched tight. When I took my Head World Cup boots out of the box and put them on I immediately sensed the tongue pressing firmly against the base of my shank. This was before I even tried to dorsiflex my ankle (rotate my shank forward). The curve of the transition of the tongue felt like a block pushing against the base of my shank.

Most plastic tongues amount to bent half tubes. One of the stiffest shapes known is a tube. When the trailing edges of a ski boot tongue are loaded by the leading edges of the boot liner and the curved interface of the boot shaft, the shank portion of the tongue becomes substantially rigid. When the shank presses against the tongue it bends at its transition with the forefoot portion. When it bends, the curve at the transition flattens and the tongue body moves rearward towards the shank. Unless the tongue is sewn to the toe box of the liner so it is too far forward, it can press on the lower end of the shank and block the glide path of the ankle joint. Here is a simulation of what happens. The black line represents the profile of the tongue.


This issue was identified in my US No. 4,534,122 and in a series of X-ray video studies done by Professor M. Pfeiffer (Kinematics of the Foot in the Ski Boot – The Shoe in Sport).  In the Type C study Dr. Pfeiffer observed that, among other things, the physiologic function of the ankle is stopped prematurely (blocked) with the effect that the talus (the bone that forms the ankle joint with the tibia) is levered backward and upward within the boot shell. The previous short video clip and the clip that follows below show this effect. If you pause the videos before and after shank loading you can see the extent of the effect of the tongue bending at the transition and pressing against the base of the shank. The flattening effect at the transition is due to the manner in which the stiffness of the half tube shape of the tongue influences the deformation.


Note how the foot is forced backward in the boot and the entire forefoot lifts off the boot board. This effect is easy to demonstrate with foot pressure technology by having the subject apply firm pressure to the balls of the feet and then flex the boot. As boot flex progresses, the pressure seen on the monitor under the balls of the feet will progressively decrease then disappear. The reason for this is that ski boots are flexed by decreasing the contraction of the soleus muscle. This has the effect of turning off the connection of the tibia with the balls of the feet. In his article, Dr. Pfeiffer stresses the importance of the forces on the shank in the fore aft plane being the result of active muscle participation and tonic muscular tension and that if muscular function is inhibited in the ankle area, greater loads will be placed on the knee. Tonus in a muscle is a reflex state where the muscle is primed and ready to rapidly respond to a neural signal to contract.

In my next post I will discuss the modifications I make to my boot tongue to try and minimize ankle glide path block.




This post is about how tongues in ski boot can affect balance.

Every ski boot has some sort of tongue. In the case of rear entry boots or liners like the Intuition, a portion of the liner acts in the capacity of a tongue. So what exactly does the tongue do? The obvious job of the tongue is to the pad the shin and spread the load applied by the shank to the front of the boot shaft.

What about the forefoot portion of the tongue over the instep of the foot? What does it do? As far as I have been able to ascertain, for most skiers, not much. Seriogram X-Ray studies done for me in 1995 found that in the boots of some skiers, there was a significant crash space between the top of the forefoot portion of the tongue and the inner surface of the boot shell. A lack of constraint or load applied to the instep of the foot of a skier means that the entire foot can float within the boot shell in response to perturbations in snow reaction force. Typically, when a skier’s CoM is perturbed, the plantar foot separates from the insole on the liner. If the skier is thrown off balance and pitches forward, the heel of the foot moves up as the foot rotates about the balls of the foot. This is an issue that the in-boot technology in my US Patent No. 4,534,122 addressed.

But ski boot tongues can do other things that you may not be aware of. The tongue can act in the capacity of a spring that opposes and progressively loads the shank in ankle flexion. Worse, it can  obstruct the glide path of the ankle joint. When the now ubiquitous power strap that is present on most boots today is cinched up tight, the tongue can act as an effective splint for the ankle.

In my last post, MOMENT OF THE SHANK IN THE SHAFT,  I used a simulation to show how my shank can move with little resistance from the shaft for about 14-16 degrees within the front to back free space within the shaft. In his article, Kinematics of the foot in the ski boot, Dr. M. Pfeiffer refers to this as the lead segment of shank flexion. Here is what it looks like in my Head World Cup ski boot.

Lead segment

The red line emanating from the fixation of the shaft of the boot indicates the proximate point about which deformation of the front of the cuff will occur. As my shank encounters the front of the shaft I want the load centre to remain substantially fixed and the resistance to predictably increase so my balance system can work with it.

The load applied by my shank is to the top edge of the front of the shaft of the boot. This is the centre of the load. The load is distributed by the tongue above and below the load centre. I like to have a little more load on my shank below the load center than above the load centre. The red arrows and bar with the dots in the photos below show this. I don’t want to have any load on my shank below the lower aspect of the load distribution.

C of Force

Here is what the stock tongue from my boots looked like after I performed a tonguectomy procedure that removed it from the liner.

Tongue section

Here is what the tongue looks like overlaid on my ski boot.

Tongue overlaid

Note the flat profile. In order for the tongue to conform to my foot and leg either my ankle has to severely plantarflex or my the tongue has to bend. I suspect that tongue is made this way to act as a sort of shank-shaft  shoehorn to facilitate entry of the foot into the boot. Since I can’t stand up let alone ski with my ankle plantarflexed, the tongue has to bend. By what? By my shank applying a force to it. In this configuration the tongue is acting like a spring pushing against the shank of my leg in places where I don’t want any load.


I push on the tongue, the tongue pushes back. But it can be worse than that especially if the tongue is too far back as it was in my boots. The tongue is fixed (usually sewn) to the toe box of the liner. The first time I put my boots on (the liners were intact then) and operated the buckles it felt like a steel rod was jammed into the base of my shank. If I tried to flex my ankle I could feel that the glide path of the joint was impeded. So I would get an initial load on my shank at its base followed by a secondary load at the top of the shaft superimposed over the first load. To me, the feeling is like running up a flight of stairs and catching the toe of my lead foot on a stair nosing. I call this kind of unpredictable loading the ‘trip effect’ because it feels similar to tripping in terms of the effect on my balance.

In my next post I will discuss the tongue modifications I typically make.