immobilize

FIT VS. FUNCTION

With rare exceptions, the consistently stated objective of boot-fitting systems and modification efforts is to create a perfect fit of the foot and leg of a skier with the rigid shell of a ski boot by applying uniform force to the entire surface of the foot and the portion of the leg in the boot in what pits Fit against Function. The end objective of the Perfect Fit is to achieve a secure connection of the leg of the skier with the ski. In the name of achieving a secure connection of the foot with the ski, the function of the skiers’ foot has become unitended collateral damage.

But boot design and boot fitting effors didn’t start off with the intent of compromising the physiologic function of the foot. It just sort of happened as a consequence of the limited ability to change the shape of the rigid plastic ski boots to address issues of user discomfort when plastic boots were first introduced. The new plastic boots worked well for some skiers. But for most, myself included, my foot moved around inside the shell when I tried to ski. The feeling of insecurity created by the looseness made skiing with any semblance of balance or control impossible. The fix seemed to be a simple matter of trying to figure out where to place a pad or pads between the foot and shell to stop the foot from moving.

In 1973 when I first started tinkering with my own ski boots the craft of boot fitting barely existed. Like myself, those who were trying to solve the problem of a loose fit were doing proceeding by trial mostly with alot of errors. After what seemed like unending frustration from many failed attempts at trying to find and then solve the source of my loose fit, a consensus began to emerge within the ranks of the ski industry that the easiest and quickest solution was a process that would create a tight fit of the foot everywhere with the boot instead of wasting time trying to find the elusive right place to add pads. The Perfect Fit was born.

Injected foam fit was first off the mark as a Perfect Fit solution. But injected foam fit wasn’t tight or precise enough for my standards. So I tried to take the Perfect Fit to the next level with Crazy Canuck, Dave Murray. I started the process by carefully trimming and laminating together pieces of sheet vinyl to form a matrix of solid material that I inserted into the liners of Mur’s boots. The process took about 2 weeks of painstaking effort. Finally, I satisfied that Mur’s feet were securely locked and loaded; ready for the best turns of his life. The result? One of the world’s best racers was instantly reduced to a struggling beginner, the exact opposite of what I had expected! This experience served as a wakeup call for me; one that caused me to rethink what I thought I knew and question whether the Perfect Fit was the best approach or even the right approach.

I started looking for alternate ways to restrain the foot so it was secure in the shell of a ski boot without compromising foot function. In 1980 when I was building a pair of race boots for Crazy Canuck, Steve Podborski I literally put my finger on the solution when I pressed firmly, but not forcefully, on the instep of his foot just in front of the ankle and asked if he thought we should try holding his foot like this in his new race boots. Without the slightest hesitation he said, “That feels amazing. Let’s do it!”

It took me more several few days to fabricate a system to secure Pod’s foot in his boots by loading the area of the instep that I had pressed my finger on. The problem we faced when the system was finished was that the liner made it impossible to use the system without modifying it. So a decision was made to eliminate the liner except for the cuff portion around the sides and back of his leg which I riveted to shell. At the time I wasn’t sure the system would even work. So I made a pair of boots with fined tuned conventional fit as backup. A boot with no liner seemed like an insane idea. But Podborski was not only able to immediately dominate his competition on the most difficult downhill courses on the World Cup circuit but go on to become the first non-European to win the World Cup Downhill title. Even more remarkable is that in his first season on the new system he was able to compete and win less than 4 months after reconstructive ACL surgery.

What I discovered set me off in a whole new direction. Pressing on the instep of Podborski’s foot activated what I later found out is called the Longitudinal Arch Auto-Stiffening Mechanism of the Foot. This system is normally activated as the mid stance (support) phase of walking approaches late mid stance where the foot is transformed into a rigid structure so it can apply the forces required for propulsion. As I learned about the processes that transform the foot into a rigid lever I began to understand how interfering with the function of the foot can compromise or even prevent the Longitudinal Arch Auto-Stiffening Mechanism from activating and, in doing so, cause the structures of the foot to remain ‘loose’ regardless of any efforts made to secure it.  A rigid foot is necessary to effectively apply force to a ski.

The graphic below shows a sketch on the left from Kevin Kirby, DPM’s 2017 paper, Longitudinal Arch Load-Sharing System of the Foot (1.) Figure 44 A on the right is from my 1993 US Patent 5,265,350.

The above graphics clarify the details of the arch loading system I first disclosed in my US Patent 4,534,122. This system challenges the current Perfect Fit paradigm in which the physiologic function of the foot is compromised in an effort to try and achieve a secure connection of a skier’s foot with the ski.

Figure 44A above shows the principle components of the arch loading system which is comprised of a number of complimentary elements. I will discuss these elements in my next post which will focus on solutions.


  1.  Kirby KA. Longitudinal arch load-sharing system of the foot. Rev Esp Podol. 2017 – http://dx.doi.org/10.1016/j.repod.2017.03.003

 

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.

THE MYTH OF PRONATION AND THE COLLAPSING ARCH

If you purchased a pair of ski boots or had work done by a boot-fitter you may have been told that your feet pronate and that this will cause your arch leg to collapse creating a myriad of problems including a lack of control and especially an inability to effectively transfer energy. You may have also been told that your foot functions best in skiing when it is immobilized, preferably in a neutral position, one that completely prevents pronation. All of the preceding are myths. But more than simply being untrue, they are potentially dangerous. ‘Pronation is bad’ is nothing more than a good story; one that most people buy into simply because they have no idea of what pronation is. So they tend to assume that the store clerk or boot-fitter actually knows what they are talking about.

When I first started modifying ski boots in 1973 in an attempt to help my own skiing I bought into the pronation is bad story after reading an article in a running magazine about how over-pronation (an invented term) was causing injuries in runners. The article implied that the human feet, far from being a marvel of complex engineering, are riff with problems like ‘pronation‘  that require corrective devices such as footbeds or prescription orthotics to make feet function properly. This made sense to me at the time, but only because of what I didn’t know. After reading the story in the running magazine, I had what I thought was an epiphany; ‘If foot defects can cause a myriad problems in running, imagine what havoc they must be wreaking in skiing’. Thinking I was on to something, I had prescription orthotics made for my wife and myself by a sports podiatrist. Later, I began making custom footbeds for ski boots. In the 1970s, I was one of the few boot-fitters in world making custom footbeds. And while the response of the majority of skiers I made them for was overwhelmingly positive there was one problem, my own custom footbeds didn’t work for me. In fact, footbeds and prescription orthotics made skiing much more difficult for me than insoles with no arch support. Unfortunately, the pronation is bad story caught on. Soon the evils of over-pronation morphed into the evils of pronation period; any and all pronation was bad and should be stopped or at least greatly restricted.

As Mark Twain quipped, “It ain’t what you know that gets you into trouble. It’s what you know for sure that just ain’t so”. For the past 30 years most of the world has known for sure that pronation is bad. Now a study published this month (1) confirms what I and others have maintained for years, not only is pronation not a predisposition to injury but there are significantly less injuries in those whose feet pronate.

Far from being a bad thing in skiing, pronation is the key to setting up the over-centre mechanism that makes the forces of skiing work for you instead of against you. So what is pronation?

In future posts I will explain what pronation is and why it is essential to sound ski technique and the ability to balance on the outside ski.


1.  British Journal of Sports Medicine (http://bjsm.bmj.com/content/early/2013/06/12/bjsports-2013-092202.abstract?sid=3e90eba8-f3ca-46f7-88e0-d8a28f83b729)

Sources of the story on the Danish study include:

A Popular Myth About Running Injuries – New York Times
http://well.blogs.nytimes.com/2013/06/26/the-myth-of-pronation-and-running-injuries/?_r=1

Speciality running shoes may not reduce injuries – Health – CBC
http://www.cbc.ca/news/health/story/2013/06/27/running-shoes-injuries.html

KNEE INJURIES – PART 2

When I started skiing in 1970, the buzz was all about the new safety bindings. Debates raged in magazines and ski shops over which binding was the best as in the safest. After years of skiing being perceived as dangerous because of the incidence of broken legs, a new era had arrived with the introduction of a generation of sophisticated bindings. This created the perception that it was finally safe to go out play on the ski hills. But as the sound of snapping leg bones faded into the background it was replaced by an even grimmer sound; the popping of knee ligaments, in particular, torn ACLs. Before the introduction of the rigid plastic ski boot, few skiers had ever heard of an ACL. That was about to change.

It was about the time that I started working with National Ski Team members in 1977 that I began to hear of racers suffering knee injuries. Knee injuries seemed to start with a trickle. I can’t even recall hearing of a recreational skier suffering one. Like most skiers, I believed that the new bindings had addressed the injury issue. Even after knee injuries started to increase in frequency I thought it only a matter of time before refinements would be made to ski bindings and that this would be the end of them. As the popping of ligaments got more frequent, panic seemed to set in in the industry. Skiing had entered a period of vigorous growth. The last thing it needed was a good news, bad news story as in, “The good news is that the rigid plastic boot has made skiing easier. Now for the bad news…..”. As best I can recall, it was around 1980 that a team of spanish orthopaedic surgeons published a study linking the introduction of the rigid plastic boot to knee injuries noting that the incidence appeared to be rising in lock-step with sales of the boot. A classic problem-solving strategy is to go back to the time when a problem first emerged and look for anything that changed. In this case, the most significant change was in the boot. Meantime, those with expertise in biomechanics were pointing out that by stiffening the ankle the boot was sending the forces of skiing upward to the relatively weak knee.

In retrospect, it seemed like it should have been obvious that encasing the foot within what amounts to an orthopedic splint would act to transfer force up the leg. It’s ironic, if not erroneous, that the industry, even today, talks about the boot transferring energy to the ski as if this were the end game of skiing. The reality is that unless the ski industry has repealed Newton’s Third Law (which is doubtful), if a skier were to transfer energy to anything through the boot it would be through the stack of equipment between the sole of the boot to the source of Ground (or Snow) Reaction Force at the snow. This being the case, according Newton’s Third Law which states; “For every action there is an equal and opposite reaction”, the snow will transfer an equal amount of energy through the stack of equipment back up the skier’s leg to the knee. The issues are way more complex than a simple transfer of energy. But I will start with the simple and obvious then build from here.

The question is, “Given the established reputation of skiing as being a dangerous sport prior to the introduction of the rigid plastic ski boot and the fact that skis attached to the foot and leg act as force multipliers, did anyone consider the implications of trying to immobilize the foot and leg within a rigid plastic ski boot?”

A CINDERELLA STORY: THE ‘MYTH’ OF THE PERFECT FIT

Everyone knows that the ‘Holy Grail’, the ultimate fit of a ski boot, is achieved when the shape of the ski boot perfectly matches the shape of the foot and the foot is completely immobilized. The reason given for immobilizing the foot is that this is how the foot functions best in skiing. We know this to be true because it is what everyone has been saying for decades. So it must be true. Or is it? If it were true, then those who promote the idea should be able to explain how immobilizing the foot with a perfect fit of the boot with foot makes the foot function better in skiing. But there’s one small detail – no one can. Immobilizing the joints of the foot (if it were even possible without fusing every joint) would render it dysfunctional. So how would making the foot dysfunctional make it function best for skiing? It wouldn’t. And no one can possibly explain, using sound principles of science and contemporary knowledge of functional anatomy how making the foot and leg dysfunctional would serve any useful purpose.

Here’s the reality. The human system is an amazingly complex, extremely sophisticated organism.  Despite appearances that suggest otherwise, the human lower limbs are one of the most complex anatomical structures known. The human foot and ankle complex is a strong, sophisticated mechanical structure consisting of 208 functional elements and 200,000 nerve endings with 28 bones, 33 joints (20 of which are actively articulated), and more than a hundred muscles, tendons, and ligaments. It is one of the most dynamic organisms in the human system. Yet the footwear industry continues to view foot in the paradigm of an inanimate, solid shape as reflected in static shoe lasts, which even today remain the de facto model of the human foot. The Perfect Fit is elusive because it doesn’t exist except in fairy tales. It’s nothing more than a Cinderella story.

Ski Boot Last