My 14 year old daughter has recently developed swelling and pain in the forefoot area. The swelling is in the center of the foot, and was initially directly below the metatarsals, and now appears to be mainly between the metatarsals and the toes. She is in a pair of Salomon Instinct boots - 98mm last; 90 flex; custom shell heat molded; liners heat molded. She has been in these since December 2011, and did not have these problems until I put a new pair of footbeds in. The first beds were off the shelf Conformable Volcano, thin, with moderate arch support. The second pair were slightly thicker, and with much more pronounced arch support; also off the shelf non-custom. Her first two ski days this season were still with the new pair, then I swapped them for the old pair, and the pain has lessened significantly but is still present.
Shell fit a couple of days ago showed a slight contact between baby toe on the right foot, indicating a punch out is needed there; but decent wiggle room at the left baby toe side. Pain is worse on the right foot, but still present on the left side. Other shell fit parameters look fine (length, width, instep height, etc.).
Boots have a rather pronounced forward lean.
Foot shape is narrow forefoot and heel, high arches, moderate instep (in my judgement). She does pronate. She is also very slightly knock-kneed, which the Salomon boots sorted out nicely right out of the box.
FYI, she also has this problem in her cycling shoes (SPD pedals), which is another issue to be fixed somehow. She does not have this problem in her other sports footwear -- she plays competitive soccer (6 hrs./week training and game time), as well as school sports (volleyball, field hockey). It seems that pressure on the metatarsals is the common factor, given the cycling shoe problem.
In light of that, I have removed some widgets from the heel area inside her ski boots that were tightening the heel pocket but also increasing the ramp angle. Also, I have been paying more attention to how she buckles her boots - looser over the toes and instep, tighter at the cuff. Both of these seem to have helped as well.
[snip]
-- What are the advantages/disadvantages of posted vs. non-posted? Specifically in this context - high arches; pronation; forefoot support; metatarsal pain.
-- Is a custom footbed even appropriate for a growing teenager? Her feet have not grown in the past 18 months, but they may change their shape (as evidenced by the rt. foot baby toe contact, which was not present at first bootfit session. Therefore I am reluctant to get custom footbeds, only to have to replace them every season until she is an adult. I am thinking a semi-custom like an A-Line or Footbalance, with an added metatarsal pad, may be OK. However, if custom is the way to go to avoid chronic permanent problems, then it's worth the money.
Any other suggestions or insight, non-footbed related, would of course be most welcome as well. BTW, we will also have her checked out by a podiatrist to ensure that there is nothing structurally wrong there. She has had several bad ankle sprains from soccer which may be contributing to the problem. Well worth looking at.... Finally, if the Instinct is fundamentally the wrong boot for her, then we will get her into something more anatomically suitable, but we're not at that point yet.
I've seen that problem before. Please take everything I say about this with a bucket of salt, because I'm not an actual bootfitter, and am working off memory from a couple years ago. If I remember right, that problem is often caused by footwear that's too narrow compressing the metatarsals and inflaming the soft tissue between. I suspect the new footbed aggravated it because it lifted her foot higher in the boot, which took up more volume and pushed her into a narrower part of the shell. When you fit the width of a boot to a foot, you need to measure the foot with full weight on it, because feet expand when they get weight--especially flexible feet like many young people have.
I suspect the reason she has similar problems in her cycling shoes and not her other athletic shoes is because her cycling shoes are narrow and are constructed such that the forefoot doesn't stretch, whereas most soccer cleats and such are made of leather, which stretches to fit the foot beautifully.
Regarding footbeds, with growing feet, you'd probably need to get new ones made annually and, unless there's something structurally wrong with her feet, it seems like a lot of money to spend. Pronation isn't a bad thing. It's what the foot does when you put weight on it--if you read up on barefoot running, it'll give you a different perspective on how feet have evolved to work and what's actually necessary for them to function correctly. That's not to say your daughter's skiing wouldn't benefit from a footbed--a flexible one that supports her foot but still allows it to articulate within the boot would probably do good things for her. In my opinion, the problem with rigid footbeds is that they lock the foot inside the boot, rendering the foot and ankle useless for skiing. If you want to get the ski on edge, you have to do it from the knee, which I don't think is a good thing, both functionally and for the future health of the knee. For a flexible foot like mine, a rigid footbed also causes excruciating pain, because it doesn't allow the foot to bear weight where it's supposed to. When you take it back to the magazine- and forum-recommended shop who made it for you, they add more posting (and pain) each time until you stop coming back. Ask me how I know..
I think a good place to start would be to have your daughter put all her weight on the ball of one foot with her foot flat on the floor, and measure her forefoot width (do this for each side). I'd make sure her boots were stretched or ground to fit this measurement at the height her foot sits in the boot (ie, include footbed height in making sure you're stretching/grinding at the right height).
Soft tissue, once inflamed, tends to swell and be more sensitive to pressure, so you might have to stretch/grind more than ideal to get it to stop hurting when she skis on it. Another option would probably be to get her out of her ski boots and cycling shoes for a couple weeks to see if the inflammation goes away, and you can get a better measurement.
Hopefully you'll be able to get this sorted out quickly for her!
Home
Login
Register