custom orthotics

WHO NEEDS FOOTBEDS? NO ONE

There are some who can benefit from footbeds or orthotics and some who do actually need them. But these groups are the rare exception. And they are unlikely to be skiers.

Orthotics. The pros / cons of orthotics in today’s society!

In a recent YouTube video (1.), Podiatrist & Human Movement Specialist, Dr Emily Splichal, explores the concept of orthotics and their role in today’s society. Dr. Splichal doesn’t pull any punches when she says:

“…..I have been through the conventional podiatric school and been fed pretty much the bullshit from podiatry of how every single person needs to be in orthotics, that our foot is not able to support itself without orthotics……if we do not use orthotics our foot is going to completely collapse  and you are going to lose your arch…….”

“……Our foot is designed to support itself. If we actually needed orthotics, we would be born…..we would come out of the womb, with orthotics on our feet.”

Meantime, The Foot Collective  asks (2.) Are you promoting weak feet?

  • Anything you use for artificial support at the feet (footwear with arch support & orthotics) your brain takes into account and accommodates for it.
  • That means if you provide your foot support your brain shuts down the natural arch supporters to reduce un-necessary energy expenditure.
  • Stop using support to help with pronation and understand why your feet pronate in the first place – because they are weak.
  • Strong feet = strong foundation = strong body.

The Real Source of Support for the Arch

Ray McClanahan, D.P.M. offers a perspective on the issue of Arch Support in his post on the CorrectToes blog (3.)

Are Custom Footbeds and Orthotics better than stock insoles?

In his post of August 20, 2017, Custom Foot Orthotics; No Better Than Stock Insoles (4.), Rick Merriam, of Engaging Muscles, explores the issue of orthotics in depth.

Prior to being told that supportive insoles are the way to go, I think it’s safe to say that all of those people didn’t know what they didn’t know.

The erroneous assumption that every skier needs footbeds or orthotics was made at a time when little  was known about the function of the foot and lower limb, especially in late stance. I was one of those who didn’t know what I didn’t know when initially when down the ‘the foot needs to be supported in skiing’ road up until I realized what I didn’t know and took steps to acquire the requisite knowledge.

Footbeds; is anyone checking what they do?

In 2000, I formed a company called Synergy Sports Performance Consultants (5). Synergys’ product was high quality information. One of my partners, UK Podiatrist, Sophie Cox, was trained by Novel of Germany and was one of the few experts in the world at that time on the Pedar system. Synergy did not make and/or sell footbeds or orthotics. Instead, we checked the effect of footbeds on skier performance. We performed a quick footbed check for a minimal fee of $20 using the sophisticated Novel Pedar pressure analysis technology.

Synergy was one of the first companies in the world to use the Novel Pedar pressure analysis system synchronized to video to acquire data on skier performance and analyze the captured data.  The Synergy team with diverse expertise studied the effect of ski boots and custom insoles on skier performance and identified functional issues in the body that needed to be addressed. It was a common finding that custom footbeds were significantly compromising skier performance, especially the ability to create the necessary platform under the foot on which to stand and balance on the outside ski.

Synergy offered a comprehensive 5 Step Performance Program that started with a footbed check. A key component was item 2., the Biomechanical Check.

With increasing recognition of the negative effect of most footwear on the user and criticism of the unproven claims made for footbeds and orthotics coming hard and fast, credibility in skiing is rapidly going downhill. It is time for proponents of custom insoles for ski boots to support their claims with solid evidence, especially evidence supported with data acquired during actual ski maneuvers. The technology to do this has existed since at least the year 2000.


  1. https://youtu.be/CIRf9WHmMXI
  2. http://www.thefootcollective.com
  3. https://www.correcttoes.com/foot-help/articles-studies/arch-support/
  4. http://www.engagingmuscles.com/2017/08/20/custom-foot-orthotics/
  5. DIGITAL SALVATION FOR THE SOLE [BACK TO THE FUTURE] –  http://wp.me/p3vZhu-24g

SHOE/LINER HACKS

There is no point in continuing my discussion of the mechanics of balance on the outside ski because the odds are great that ski boots are preventing most skiers from engaging the mechanics required to apply the torsional forces to a ski with which to establish a balance platform under the outside foot.

In the scheme of things, an essential first step is to adapt the ski boots to functional needs of the skier as opposed to forcing the skier to adapt to the limitations imposed on them by the ski boots. Tightly fitting, supportive ski boots and most conventional constricting, cushioned, supportive footwear actually makes the feet weaker while compromising postural alignment and balance. There is an emerging global movement that is recognizing conventional footwear as THE problem behind compromised foot function while creating a ‘perceived need’ for cushioned soles  and artificial support in the form of custom insoles and orthotics which, instead of solving functional issues in the feet, lower limbs and entire body, further weaken the biokinetic chain.

The links below are to 3 articles that speak to this subject.

ORTHOTICS OR NOT => OUR LIMITING FOOT BELIEFS ARE HURTING US – http://kristinmarvinfitness.com/orthotics-or-not-our-limiting-foot-beliefs-are-hurting-us/

YOU WERE BORN WITH PERFECT FEET – https://www.correcttoes.com/foot-help/feet-101/

STRENGTHENING VS. SUPPORTING: THE COMPETING LOGIC OF FOOT HEALTH – https://www.correcttoes.com/foot-help/strengthening-vs-supporting-competing-logic-foot-health/

There is currently a whole series of Foot-Cast Episodes on The Foot Collective site at – http://www.thefootcollective.com

see – THE HUMAN GUIDEBOOK FOR SWITCHING TO BAREFOOT FOOTWEAR


A good starting point is to acquire a sense of how day-to-day footwear compromises foot and lower limb function and the modifications or ‘hacks’  necessary to adapt the footwear to the functional needs of the user.

A recent post on the Correct Toes blog called ‘How to Modify Your Shoes to Better Fit Your Feet’ (1.), comments on a runner who was experiencing distracting numbness and tingling in her feet, but balked at allowing her coach to make a few cuts in the upper material of her shoes to relieve the tension that was causing her problem. Most people are uneasy with the idea of modifying footwear. They tend to readily accept standard, off the shelf shoe size fit and assume that the way a shoe fits (or doesn’t) fit their foot is the way it is supposed to fit.

I recently had a similar experience with a young ski racer whose toes were crunched up in her ski boots that were both too short and too narrow. The liners were especially bad. Like many of today’s young racers, early in her racing career, she had probably grown accustomed to the constraint imposed on her feet by her ski boots and had unconsciously learned to make her feet comfortable by standing with most of her weight on her heels. After a time, her body had come to accept this as ‘normal’. Once this happened, she became reluctant to make changes.

A ex-racer, who I worked with back in the 1970s, loaned the young racer a pair of her boots. The improvement in the racer’s skiing was immediate and remarkable. Her coach commented that she had made 6 months improvement in one day! Unfortunately, stories of skiers and racers whose foot function, balance and even the function of their entire body has been compromised by tightly fitting, supportive ski boots is common. But happy outcomes, such as this young racer experienced, are exceedingly rare.

The Correct Toes post offers some good suggestions on footwear modifications that are remarkably similar to those I have used for decades in both ski boot liners and in my own footwear. The reason the modifications are similar is that the end objective; creating a functional environment for the user by minimizing the negative impact of the footwear on foot function, is the same.

The series of photos that follow illustrate examples of modifications that can improve the functional fit of footwear. An easy modification is to reconfigure the lacing pattern. Just because a shoe has a specific set of lace eyelets does not mean they all are necessary. The 2 photos below are from the Correct Toes article.

Photo with permission of Correct Toes

The photos below are the lace hacks I made on my Xero Prio (left) and Lems Primal 2 (R).

One modification that the Correct Toes article does not mention is the use of lace locks. Lace locks allow lace tension to be regulated and maintained without the need to over tighten laces to prevent them from coming undone.

This is one form of lace locks on my Xero Prio.

This is another form of lace locks on my Lems Primal 2.

I also use Correct Toes to improve foot function.

Correct Toes, The Foot Collective, EBFA, Feet Freex, EM Sports and many others are advancing on a uniform front in lock-step with the makers of minimal shoes in recognizing the damage caused to feet by conventional footwear while moving towards a uniform standard for the design and construction of footwear that creates a functional environment for the foot, while minimizing the negative impacts associated with structures placed on the human foot. Technologies such as NABOSO hold the promise of advancing on barefoot function in what I like to call ‘Beyond Barefoot’.

It has long been my experience that liners are the most problematic aspect of most ski boots. When I worked exclusively with Langes, I often made extensive modifications to liners that included using a liner a size larger than the shell size and re-sectioning and/or re-sewing the forefoot to allow proper alignment of the big toe and adequate width for the forefoot to fully splay.

The biggest problem in ski boot liners is in the toe box, especially the shape of the toe end in that it forces the big toe inwards, towards the center of the foot.

A modification that the Correct Toes article suggests is to make small slits on the side of the footwear opposite the point where the foot needs more room to splay.

Photo with permission of Correct Toes

Cutting small slits along the base of a ski boot liner is the first hack I usually try. But in many cases, I find more drastic modifactions are necessary in order to obtain the width required for the foot to fully splay and the big toe to align properly.

The photos below are before (L) and after (R) modifications that were necessary to accommodate my wife’s feet. These are older race stock Lange liners which I fit to her extensively modified Head boot shells.

The photo below is of the modified liner from my Head World Cup boot.

For ‘shallow’ feet or feet with a low instep the Correct Toes article suggests adding tongue depressors along the top of the foot or under the laces to help fill the void and prevent the foot from lifting or sliding around.Photo with permission of Correct Toes

The photo is of forefoot/instep retention pad that applies a constraining load to the foot that is substantially perpendicular to the transverse plane of the boot board. This device is similar to the one that powered Steve Podborksi to the podium in World Cup Downhill races. Today, Steve remains the only non-European to have ever won the World Cup Downhill title.

I devoted a large portion of my US Patent 5,265,350 to laying the groundwork for a functional standard that could evolve and eventually be applied to all forms of footwear, but especially ski boots. There are encouraging signs that the ski industry has finally started to take baby steps in this direction. I will discuss this in my next post.


  1. https://www.correcttoes.com/foot-help/modify-shoes-better-fit-feet/ 

THE MECHANICS OF BALANCE ON THE OUTSIDE SKI: WINDLASS POWER

Two factors can prevent a skier from being able to develop a platform under the body of the outside ski on which to stand and balance on during a turn using the same processes used to balance on one foot on solid ground:

  1. The biomechanics of the foot and leg have been compromised by traditional footwear and,
  2. The structures of the ski boot, especially insoles, footbeds, orthotics and form fit liners, are interfering with the foot to pelvic core tensioning of the biokinetic chain that starts in the forefoot.

The torsional stiffening of the ankle and knee joints resulting from fascial tensioning of the biokinetic chain is fundamental to the ability to create a platform under the body of the outside ski by internally rotating the outside leg from the pelvis. It may sound complicated. But it is actually quite simple. Once learned, it can become as intuitive as walking.

The best method I have found to appreciate how ski boots, custom insoles and form fitting liners can affect the function of the feet and even the entire body, is do a series of exercises starting with the short foot. The short foot helps to assess the ability to harness the Windlass Power associated with the big toe. Once proper function has been acquired in the foot and leg, a skier can go through a methodical, step-by-step process to assess the effect of each component of the ski boot on the function of the feet and legs.

The latest edition of Runner’s World (1.) reports on a study done by a team at Brigham Young University that compared the size and strength of the foot’s “instrinsic” muscles in 21 female runners and 13 female gymnasts. Gymnasts train and compete in bare feet.

The researchers found:

Of the four muscles measured with ultrasound, the gymnasts were significantly bigger on average in two of them, with no difference in the other two. The gymnasts were stronger in their ability to flex their big toe, with no difference in the strength of the second, third, and fourth toes.

Although balance is important in all sports, it is especially critical in gymnastics. So it is significant that study found that the big toes of the gymnasts were stronger than the big toes of the runners.

Until recently, I found it much easier to balance on my left leg than my right leg. The big toe on my left foot was noticeably larger than the big toe on my right foot and the big toe on my left foot was aligned straight ahead whereas the big toe on my right foot was angled outward towards my small toes. This misalignment had pushed the ball of my foot towards the inside of my foot causing a bunion to form on the side, a condition known as hallux valgus. I now understand why I could balance better on my left foot than my right foot.

The muscle that presses the big toe down is called the Flexor Hallucis Longis (FHL). It is inserted into the last joint of the big toe where it exerts a pull that is linear with the big toe and ball of the foot. When the arch is maximally compressed in late stance, the Flexor Hallucis Longis is stretched and tensioned causing the big toe to press down. It’s insertion on the upper third of the fibula causes the lower leg to rotate externally (to the outside). When stretched, the FHL acts in combination with the Posterior Tibialis to support the arch. Footwear that prevents the correct alignment of the hallux weakens the arch making it more difficult to balance on one foot; the foot pronates unnaturally.

Going mostly barefoot for the past 10 years and wearing minimal type shoes for the past 6 years, made my feet stronger.  But it had minimal effect in correcting the hallux valgus in my right foot. It was only after doing the exercises in the links that follow, such as the short foot, that the big toe on my right foot became properly aligned and grew in size. It is now the same size as my left toe and I am able to balance equally well on both feet. The problem with ski boots and most footwear, is that they can force the big toe into a hallux valgus position while preventing the forefoot from splaying and spreading naturally weakening the arch and significantly impairing natural balance.

In the early 1970’s, when the then new plastic ski boots were making a presence in skiing, research on human locomotion was in its infancy. Studies of the effects of sports shoes on human performance were virtually nonexistent. The only technology available back then with which to study the biomechanics of athletes was high speed (film) movies. Ski boot design and modification was a process of trial and error. Many of the positions that predominate even today were formed back then.

As methodologies began to develop that enabled the study of the effect of sports shoes on users, biomechanists and medical specialists became convinced that excessive impact forces and excessive pronation were the most important issues affecting performance and causing or contributing to injury. I suspect that biomechanists and medical specialists arrived at this conclusion even though there was little evidence to support it because it seemed logical. Soon, the term, excessive pronation became a household word. The perceived solution? Arch supports, cushioned soles, motion control shoes and a global market for arch supports.  This appears to have precipitated an assumption within the ski industry that the feet of all skiers needed to be supported in ski boots and pronation, greatly restricted, or even prevented altogether. Even though no studies were ever done that I am aware of that demonstrated that pronation was a problem in skiing, support and immobilization became the defacto standard. Custom footbeds, orthotics and form fitted liners became a lucrative market.

As the support and immobilize paradigm was becoming entrenched in skiing, studies were increasingly concluding that, with rare exceptions, excessive pronation, is a non-existent condition with no pathologies associated with it and that the role of impact forces was mis-read. Today, it is increasingly being recognized that interference to natural foot splay and joint alignment of the big toe by the structures of footwear, causes weakness in the foot and lower limbs through interference with the natural processes of sequential fascial tensioning that occurs in the late stance phase. But the makers of footwear and interventions such as arch supports, have been slow to recognize and embrace these findings.

A key indicator of whether a skier has successfully developed a platform under the outside ski with which stand and balance on, is the position and alignment of the knee in relation to the foot and pelvis as the skier enters the fall line from the top of a turn. I discuss this in my post, MIKAELA SHIFFRIN AND THE SIDECUT FACTOR.

Best Surfaces for Training

A good starting point for the short foot and other exercises is Dr.Emily Splichal’s YouTube video, Best Surfaces for Training https://youtu.be/gvJjIi3h1Bs

Although it may seem logical to conclude that soft, cushioned surfaces are best for the feet, the reality is very different. The best surfaces to balance on are hard, textured surfaces. Dr. Splichal has recently introduced the world’s first surface science insoles and yoga mats using a technology she developed called NABOSO which means without shoes in Czech.

The skin on the bottom of the foot plays a critical role in balance, posture, motor control and human locomotion. All footwear – including minimal footwear – to some degree blocks the necessary stimulation of these plantar proprioceptors resulting in a delay in the response of the nervous system which can contribute to joint pain, compensations, loss of balance and inefficient movement patterns. I’ve been testing NABOSO insoles for about a month. I will discuss NABOSO insoles in a future post. In the meantime, you can read about NABOSO at https://naboso-technology.myshopify.com/products/naboso-insoles

Short Foot Activation

 

Short Foot Single Leg Progressions


  1. Here’s the Latest Research on Running Form – May 30, 2017
  2. Biomechanics of Sports Shoes – Benno M. Nigg

BOOT-FITTING 101: THE ESSENTIALS – SHELL FIT

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 – https://youtu.be/_35cQCoXp9U

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.

screen-shot-2017-02-09-at-3-55-38-pm

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.

mt-width

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.

INSOLE/FOOTBED/ORTHOTIC EFFECTS

The big epiphany I had about 1975, was that the foot needed to be supported in the new plastic ski boots and that it was a lack of support that was causing my difficulties skiing after switching from low cut leather boots to the new higher, rigid plastic boots.

Back then, I was an avid runner. As best I can  recall, it was an article in Runner’s World on running injuries caused by over-pronation that served as a catalyst for my conclusion that the foot needed to be supported in a ski boot. I assumed that what was being reported in running magazines was both factual and derived from science-based investigations. While I had not found anything in the literature that suggested that the foot needed to be supported in a ski boot, it seemed logical to me that if runners needed support in their shoes, the need for support in a ski boot was many times greater. But my conclusion was based on the assumption that over-pronation was a pathology and that it was a proven cause of injuries in running. Therefor, it was also a problem in skiing.

Pronation and over-pronation was a new concept to me in 1975. My running partners and I all ran in flats with no arch support. None of us had ever heard of, let alone experienced, knee pain or the myriad of other problems that were fast becoming an integral part of running and were claimed to be caused by overpronation.

Soon after I read the article on overpronation, I made an appointment with a podiatrist in Vancouver to have my feet examined. I was hopeful that he would find the defect(s) in my foot that were causing me difficulties in skiing in the new plastic boots. But after a thorough examination, he pronounced my feet healthy and normal. Undeterred, I made an appointment for my wife and I with a well known sports podiatrist in Seattle, Washington, almost 800 miles round trip to and from Whistler. We made a special trip to Seattle to have prescription orthotics made for our ski boots. But far from helping, they made both of our skiing worse, much worse. Still, I remained convinced that the foot needed support in a ski boot.

Between 1977 and about 1983, I made a lot of footbeds for ski boots. From the first pair of footbeds I made, I received positive feedback. Skiers loved them. Some skiers told me they would never ski again without the footbeds I made for them. Even today, I encounter skiers who are still using the same footbeds I made for them 40 years ago. Did this subjective feedback serve as evidence that my footbeds made skiers ski better? No.

By about 1989, I was still unable to understand why I was continuing to experience difficulty skiing even after trying numerous pair of plastic ski boots. At that time, I was struggling to invent and patent a ski boot based on sound principles of functional anatomy

I finally came to the realization that the only way to arrive at meaningful conclusions about how the human system should ideally function in skiing was to design and fabricate an open-architecture research vehicle, one that minimized any neural noise that was unavoidably caused by interference with the physiologic function of the user by structures of the conventional ski boot. It had become apparent to me that it is the level of ‘neural noise’ and interference to physiologic function caused by a tightly fitting ski boot that prevents anyone from proving how a ski boot affects a skier.

The Birdcage allowed the capture of data during actual ski maneuvers that showed how some of the world’s best skiers skied and especially what happened when specific joint actions were interfered with.

It was was also about 1989 that I was starting to question how an insole or orthotic fit to one ski boot could produce the same result in a different ski boot or with skis with different sidecuts, especially width underfoot and different lift heights of the sole of the foot above the surface of the snow. I was also starting to question how the same stock or custom insole or orthotic could produce the same effect when used in different shoes. A custom insole for a female might be used in casual shoes, flats, running shoes, walking shoes, hiking boots and even spiked, high heel shoes. And what happens to the effects produced by an insole or orthotic when the sole of the shoe it is used in wears unevenly?

It was obvious to me, and should be obvious to anyone, that it is impossible for an insole or orthotic to consistently produce the same effect in widely varying footwear that each affect the foot in a different way. 

Despite the many questions I was having about insoles and orthotics, I continued to believe that they had value in some applications. In the years following the Birdcage tests of 1991, my wife had two different pairs of prescription orthotics made, both by reputable labs, for issues with hip and back pain. Neither pair provided any perceivable benefit. Both pairs were eventually discarded.

The best skiing experience today for my wife and I is with perfectly flat insoles and boot boards that provide no perceivable interference with the dynamics of the arches of our feet. Even the slightest impingement is immediately perceived. All of the shoes I wear have either flat insoles or no insoles. If I purchase a shoe with an insole with arch support, I modify it to remove the support.

 

 

WHAT DO INSOLES AND ORTHOTICS DO?

According to Benno Nigg, no one knows for sure. From 1981 until he retired recently, Nigg founded and was the Director of the Human Performance Laboratory (HPL) at the University of Calgary in Calgary, Alberta, Canada. The Human Performance Laboratory is a multi-disciplinary research centre concentrating on the study of the human body and its locomotion. From 1971 until 1981, Nigg was the Director of the Biomechanics Laboratory at ETH Zurich (Swiss Federal Institute of Technology).

For more than 30 years, Nigg studied the effects of insoles and orthotics on the lower limbs. What he found was that most of the time they didn’t do what was claimed. Often, the effect of the same insole or orthotic varied greatly from one subject to another even though they had the same condition. In some cases, Nigg found that orthotics had a large effect on muscles and joints, increasing muscle activity by as much as 50% for the same movement while increasing stress on joints by the same amount as the body fought to overcome the effect of the orthotic. Nigg also found that “corrective” orthotics do not correct so much as lead to a reduction in muscle strength. He details his findings in his book, Biomechanics of Sports Shoes. The book can be ordered from NiggShoeBook@kin.ucalgary.ca

If no one knows what insoles and orthotics in footwear affect the user, how is it possible for anyone to know insoles and orthotics in ski boots affect skiers? I am not taking about claims made for insoles and orthotics made for ski boots. I am talking about how they affect the skier during ski maneuvers as confirmed by on-snow studies. The pivotal issue is how the CNS manages, or isn’t able to manage, the forces across the inside edge of the outside ski in a turn. This is what any claims should focus on. But I have yet to find evidence that any studies to this effect have been done.

You’ve been to a ski boot-fitting shop or perhaps a foot professional and had custom insoles or orthotics made for your ski boots. You may have been told that these interventions will create a specific alignment of your knees with some aspect of your feet.  You may have also been told that your feet pronate or over-pronate and that insoles or orthotics will correct these issues. In addition, you may have been told that you will ski better with the insoles or orthotics or an expectation was created that you would. This expectation may have been reinforced by the fact that you probably felt very different standing in your boots with the insoles or orthotics fit to them than you did without them.

Out on the ski hill with your boots and skis on you probably also felt different than you did without your new insoles or orthotics. But are you skiing better? You might think you are, especially after paying several hundred dollars or more. But how do you know for sure? You don’t. Unless the person who made your custom insoles or orthotics instrumented your ski boots and captured data during actual skiing both before and after the insoles or orthotics were installed and then compared the data sets to peer reviewed, independent studies that provided compelling evidence that the data captured during skiing conclusively demonstrated a positive effect of the insoles or orthotics on your skiing, any claims made were speculative and any conclusions, subjective. More important, claims tend to be biased because a product is associated with them.

You are probably thinking that none of this matters because there is an abundance of science in support of custom insoles and orthotics. But in a  New York Times article, Close Look at Orthotics Raises a Welter of Doubts – January 17, 2011 (http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all), Benno Nigg looked critically at insoles and orthotics. His overall conclusion? Shoe inserts or orthotics may be helpful as a short-term solution, preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up.”

In the same NY Times article, Scott D. Cummings, president of the American Academy of Orthotists and Prosthetists, acknowledged that the trade is only now moving toward becoming a science and that when it comes to science and rigorous studies, “comparatively, there isn’t a whole lot of evidence out there.” Dr. Nigg would agree. The proof that orthotics provide benefit? Some people feel better using them than not using them. So any evidence is in the form of highly individualized, subjective feel. What about skiing? Is claiming that the foot needs to be supported and/or especially that the foot functions best in skiing when its joints are immobilized in neutral, sufficient to claim a benefit or implied need for insoles or orthotics in skiing? Hardly.

The first thing to consider is that unless the load W from the central load-bearing axis is transferred to the inside turn aspect of the inside edge of the outside ski it is impossible for the foot to pronate. In addition, in this configuration, the outside foot cannot be ‘supported’ because there is no support in the form of a contiguous source of snow reaction force under the base of the outside ski.

When Lange introduced the world’s first all plastic ski boot in in 1962, biomechanical research on human locomotion was in its infancy. Biomechanical studies of sports shoes, including ski boots, were nonexistent. The first edition of Inman’s seminal work, The Joints of the Ankle, wasn’t published until 1976. What did it take for the new rigid plastic ski boot to be universally accepted? A few trips to the podium.

When running and jogging took off in the early 1970s, insoles and orthotics and were widely promoted in response to injuries that were erroneously assumed to be caused by excessive (over) pronation. Were there any studies to support this conclusion? No. Nor, was there any evidence that I am aware  to support the position of the proponents of insoles and orthotics that the foot needed or would benefit from support in ski boots. As far as I have been able to determine, the need to support the foot in a ski boot was and still is based on a widely accepted assumption. If pronation was a problem in running, then it had to be a problem in skiing. That made sense. Except that it didn’t. In the late 1980s and early 1990s, studies were showing that there was only minimal correlation between high pronation and high impact loading and typical running injuries. Nigg and other researchers suggested that no evidence was found because there was no evidence. Researcher had been trying to prove pronation was the cause of running injuries instead of trying to find the cause.

Two recent studies question the validity of the premise of supporting the longitudinal arch of the foot, especially in ski boots.

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Dynamic loading of the plantar aponeurosis in walking http://www.ncbi.nlm.nih.gov/pubmed/14996881

BACKGROUND: The plantar aponeurosis is known to be a major contributor to arch support, but its role in transferring Achilles tendon loads to the forefoot remains poorly understood. The goal of this study was to increase our understanding of the function of the plantar aponeurosis during gait. We specifically examined the plantar aponeurosis force pattern and its relationship to Achilles tendon forces during simulations of the stance phase of gait in a cadaver model.
RESULTS:  Plantar aponeurosis forces gradually increased during stance and peaked in late stance. Maximum tension averaged 96% +/- 36% of body weight. There was a good correlation between plantar aponeurosis tension and Achilles tendon force (r = 0.76).

CONCLUSIONS: The plantar aponeurosis transmits large forces between the hindfoot and forefoot during the stance phase of gait. The varying pattern of plantar aponeurosis force and its relationship to Achilles tendon force demonstrates the importance of analyzing the function of the plantar aponeurosis throughout the stance phase of the gait cycle rather than in a static standing position.

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For years, experts have claimed that skiing is done in the mid phase of stance in what is called the gait cycle. What the preceding study clearly shows is that the strongest stance in skiing in terms of the ability to transfer force to the head of the first metatarsal and functional stability of the structures of the foot occurs in the late phase of stance, not the mid phase. The graphic below provides a simulated representation of the sequence by which Achilles tendon force tensions the plantar aponeurosis and transfers large forces to the forefoot, especially to the head of the first metatarsal.

Foot Dynamcs 3

New studies are questioning the premise of supporting the arch of the foot with anything  because neural activity in the arch of the foot appears to  be potentiated by tension in the plantar aponeurosis and surrounding soft tissue. Rather than being a passive static entity in its role as a support structure for the superincumbent body, the arch is a dynamic, neurally charged system whose height changes in response to changes in perturbations in GRF that challenge the balance system.

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Foot anatomy specialization for postural sensation and control http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311689/

These findings show that rather than serving as a rigid base of support, the foot is compliant, in an active state, and sensitive to minute deformations. In conclusion, the architecture and physiology of the foot appear to contribute to the task of bipedal postural control with great sensitivity. Here, we show that the foot, rather than serving as rigid base of support, is in an active, flexible state and is sensitive to minute perturbations even if the entire hind and midfoot is stably supported and the ankle joint is unperturbed.

However, support of the body weight in the erect posture involves not only the counterbalancing of the gravitational load, but also equilibrium maintenance, which is dynamic in nature. Accordingly, somatosensory information on local foot deformations can be provided from numerous receptors in the foot arch ligaments, joint capsules, intrinsic foot muscles, and cutaneous mechanoreceptors on the plantar soles (Fallon et al. 2005; Gimmon et al. 2011; Kavounoudias et al. 1998; Magnusson et al. 1990; Meyer et al. 2004; Schieppati et al. 1995).

During standing, the foot arch probe and shin sway revealed a significant correlation, which shows that as the tibia tilts forward, the foot arch flattens and vice versa.

It is worth stressing that the foot represents an important receptive field, formed by numerous skin, joint, tendon, and muscular receptors (including intrinsic foot muscles), and it has long been recognized that damage to the foot, be it either by sensorineural loss or physical damage to the muscles, bones, or supporting tissues, changes posture and gait stability.

A number of cutaneous and load-related reflexes may participate in the fine control of posture or foot positioning during walking.

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Almost any structure that provides even minimal support for the arches of the foot will prevent the arch from lowering and transferring force to the MTs and will  interfere with the function of the arch as an active, dynamic neuro-sensory mechanism.

Claims made for insoles and orthotics create a reasonable expectation in the consumer that what is experienced in an off hill controlled environment will also happen on the ski slopes. Terms of disclosure require that any claims  be qualified with statements like, “These claims have not been confirmed during actual ski maneuvers”.

 

 

 

PRONATION – WHAT SHOULD IT FEEL LIKE?

Given the widespread confusion and misunderstanding surrounding pronation and it’s role in skiing that seems to exist I am going to provide some drills that will teach you how to assume a functionally pronated position.

Functional pronation is specific to monopedal (one-foot) stance especially as it relates to the ability to assume and move from one dynamically tensioned base of support to another. Once you have a feel for the functionally pronated monopedal position you can go through series of drills standing in your bare feet on a hard flat surface. Next you can stand in your ski boots starting in the boot shell after which you can add the liner with no insole followed by the liner with an insole or custom footbed. By using the feeling associated with standing in your bare feet on a hard, level, flat surface and then comparing the sensations to standing in your ski boots on a hard, level, flat surface you can experience for yourself how the various elements around and beneath the sole of your foot affect your ability to assume a functionally pronated position or even stand properly on two feet. As a prelude to providing drills on how to assume a functionally pronated monopedal stance, I will provide a brief history of the events that contributed to my current position on pronation, footbeds and insoles in general in skiing.

In my initial years of modifying ski boots I was a big proponent of footbeds. In those days, my work on ski boots was very much aligned with conventional views of immobilizing and supporting the foot and leg. But my disastrous experiences with Dave Murray got me rethinking this. By the time I began working with Steve Podborski, I was moving in a direction away from conventional thinking. In 1980, I had a huge breakthrough with a in-boot technology for which I was later awarded a patent. This was the turning point at which  severed any association I had with conventional thinking in ski boots and started fresh with a clean sheet of paper; one that did not include any premises on which existing ski boots are based.

By 1991, when Steve Podborski and I  initiated a research program to test my hypothesis on the mechanics, biomechanics and physics of skiing, my thinking was so far from convention that I insisted on retaining two scientists to provide oversight on the project. This included reviewing everything I put in writing but especially my patent. This process was intended to ensure that the principles I was using were both sound and correct. One of the scientist was G. Robert Colborne, Ph.D, an expert in the biomechanics of the human lower limbs. After reviewing my hypothesis, the initial impression of these scientists was that if it were correct it meant the whole world was wrong. Because I was in uncharted territory it was critical to me to have my findings confirmed before going forward. Once the wheels of a new technology are set in motion and significant money has been invested, it is hard to change direction, and especially to reverse direction. For this reason, we did a series of on snow studies in 1991 on Whistler’s glacier to confirm my hypothesis. I will provide details of the results in future posts.

The image below shows the model engaged in quiet standing Bipedal stance. There four positions of Centre of Mass in relation to the feet with weight distribution as follows from 1 to 4:

1. Centre of Mass is just in front of the base of the shin. The heel which is carrying about 60-70% of the load of each foot. This represents the rearmost limit of Centre of Mass. Should CoM fall behind the base of the shin, a rearward fall will result.

2. Centre of Mass is in the proximate centre of the span of the longitudinal arch. The heel is carrying approximately 50% of the load of each foot. The balls of the feet are carrying the remaining 50% of the load. The ball of the great toe is carrying twice as much load as the other 4 balls of each foot. This position represents the most stable and efficient form of bipedal stance.

3. Centre of Mass is approaching the balls of the feet. The contraction of the muscles that plantarflex (push down) the feet is increasing. The balls of the feet are carrying the remaining 60-70% of the load of each foot.

4. Centre of Mass is almost over the balls of the feet. The contraction of the muscles that plantarflex the feet has further increased. The muscles that push the toes down are now contracting forcefully, pushing the toes against the floor. This is the absolute forward limit of Centre of Mass in quiet standing. The toes act as a fail safe by pressing down onto the support surface in what is called the Reverse Windlass Mechanism. This mechanism tensions the forefoot into a rigid lever in preparation for propulsive phase of gait. At this point, almost all the weight is being carried on the balls of the feet and the toes. Should CoM pass the balls of the feet without evoking plantarflexion of the ankle, a forward fall will occur.

Screen Shot 2014-02-10 at 10.03.33 AMBIPEDAL DRILLS

These should be done in bare feet on a hard, flat, level surface. Start with the second position.

Drill 1. Stand erect with your feet a natural hip width apart and with a small angle of flexion at the knee joint. Release any tension from your body and allow your feet to settle onto the surface of the floor. Do not consciously apply force with your feet. Tune in to the pressures in your feet and buttocks. Sway back and forth slightly using only ankle flexion. Find the point at which the weight feels even between your heels and balls of your feet. You should feel slightly more pressure under the ball of your big toe than under the balls of your other toes. This is normal. Look down at your knees. They should be aligned straight ahead.

Drill 2. Using only the ankle joint, press down on the balls of your feet until you feel most of the weight on under your heels. Do not go too far. This is the limit of the rearward movement of C0P. At this point you are on the verge of a backward fall. Look down at your knees. They should be aligned straight ahead.

Drill 3. Using only the ankle joint, release the pressure under the balls of your feet until you feel more of the weight on the balls of feet than your heel. Look down at your knees. They should be aligned straight ahead.

Drill 4. Using only the ankle joint, release more pressure under the balls of your feet until you feel the weight pressing down hard on the balls of your feet and your toes. Do not go too far. This is the limit of the forward movement of C0P. At this point you are on the verge of a forward fall. Look down at your knees. They should be aligned straight ahead.

FUNCTIONAL PRONATION MONOPEDAL DRILL

1. Start from position 2 above.

2. Move your Centre of Mass slowly towards whichever one of your feet you most comfortable and confident with.

3. As you move towards one foot allow your ankle and leg to relax and roll inward, towards the L-R centre of your body.

4. When you feel the pressure strongly under the ball of your foot move, allow the ankle to relax and your Centre of Mass to move forward into position 3 above. As this happens lift the other foot off the floor. You will feel a pronounced change in the tension of the gluteus muscles in same side as your support foot in your buttocks. If your foot is functionally pronated you will feel most of the pressure under the ball of your foot.

Congratulations. You have achieved functional pronation and a dynamically tensioned base of support. Now try putting insoles and arch supports under your foot and feet. Do the same drills and see what happens.