Skis and Gear Discussion > Gear Garage
Footbeds for teenagers; forefoot pain
Svend:
OK guys, I need some objective advice on a nagging problem. I alluded to this yesterday in Byron's boot thread (now moved to the boot fit sticky in the Gear Garage), and this speaks to Dan's comments on posted vs. non-posted footbeds.
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.
Sorry for the long-winded preamble....
Next steps: in addition to the shell punch-out, I want to get her a new pair of footbeds to properly support the arches and the metatarsals. My brief chat on the phone with the shop bootfitter showed that his preference is a custom footbed, posted, to lock the foot in place. So, further to Dan's comments, I have some questions about proper selection:
-- 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.
Thanks in advance.... Looking forward to your feedback.
Svend
jim-ratliff:
Well, I almost always have a negative reaction to the posted footbed term of "locking the foot into place".
Interesting that it is also present in her bike shoes (both stiff platforms surfaces).
How well does the footbed conform to her foot out of the boot. Is it possible that her foot has grown just enough that the foot is now moved forward a few millimeters and not sitting on the footbed where it used to?
dan.boisvert:
--- Quote from: Svend on January 01, 2013, 12:28:12 pm ---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.
--- End quote ---
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.. :D
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!
Svend:
Dan, thanks again for an excellent reply. If we ever meet to ski together, I owe you a pint.
Especially pertinent are your comments on rigid footbeds actually causing pain, and the functional differences between posted, rigid beds and flexible ones. Makes perfect sense, and explains why the pain started with the 2nd set of footbeds - they were not only slightly thicker, pressing her feet upward into the shell, but they also had a high and rigid arch support and a very solid, flat base, like a posted custom bed. These obviously prevented her feet from moving, exacerbating the problems at the forefoot area. Now that the old (more flexible) footbeds are back in, the inflammation is much less severe, and is decreasing with every ski day, indicating that the area is healing. Proper buckle tension and decreased ramp have probably helped a lot too. Prior to this, the pain was so bad she actually had to stop skiing on several occasions, which is remarkable as she is a tenacious girl and a fighter. So, things are getting better, but much more needs doing before this is fixed.
FYI, since my first post earlier today I have looked into this further (check out Mortons Neuroma at some medical sites), and my research indicates that the root causes are: (a) pressure from above the metatarsals which compresses this area (eg. too much buckle tension); (b) compression of the forefoot from the sides from too-narrow footwear; or (c) localized pressure at the ball of foot area from stance such as high ski boot ramp, cycling shoes, or high heeled shoes. Several ski forums have threads on this, and women seem to be more afflicted than men. I agree with you - I think all three factors were contributors to my daughters problem.
Last week I called a few shops to poll their advice on this, and I am a bit dismayed now to have heard them all punting rigid footbeds. But to be fair, I will have a long chat with the guy at the shop where we bought these boots and did her initial fitting, whom I have not been able to speak to yet about this. I will fully explain the situation, and give him a chance to assess and make some recommendations. At very least, he will punch out the affected areas, and if he insists on a posted footbed, I will simply go elsewhere for that. I don't expect he will, though, as we spoke of footbeds for teens when he fitted her, and he recommended sticking with the simple Conformable Volcano.
Further to your comment on rigid beds causing knee problems, this makes me rethink the footbeds in my wife's boots and mine too. They are both similar to the problematic ones for our daughter - rigid, flat base; high solid arch, thicker forefoot. My wife has been complaining of knee pain lately, and my knees are tender too. Time for a re-evaluation of all this. Thanks for bringing that to light.
With regard to more flexible footbeds, do you have any experience with a specific brand? Are they simple off the shelf ones like the Conformable Volcano or Superfeet? Or are they custom? I have recently seen some interesting semi-custom heat moldable ones - Footbalance and A-Line come to mind.
Cheers,
Svend
Svend:
--- Quote from: jim-ratliff on January 01, 2013, 02:25:03 pm ---Well, I almost always have a negative reaction to the posted footbed term of "locking the foot into place".
Interesting that it is also present in her bike shoes (both stiff platforms surfaces).
How well does the footbed conform to her foot out of the boot. Is it possible that her foot has grown just enough that the foot is now moved forward a few millimeters and not sitting on the footbed where it used to?
--- End quote ---
This is possible. She has not changed shoe size in almost 2 years, but that is hardly an accurate measure. I think there are other things at work here, though....see my reply to Dan re. the 2nd set of footbeds I put into her boots, and their rigid design. I'm feeling pretty badly about this, actually, thinking I might have caused all her discomfort. I bought those beds under the mistaken assumption that rigid was better, given everything I'd heard the shop guys say over the years re. custom posted ones.
Now that I think about it, the only bootfitter that I have ever heard speak about allowing the foot to articulate, and building a footbed to on that principle, was a woman in Banff who did some work on Gary's Langes last April. I may have to go and see her on our next visit there if I can't find anyone here locally. She apparently does some of the WC racers on the Canadian alpine team, who are more than delighted with her work.
Jim, what has your experience been with this? From your comment above, you seem to know a bit about posted footbeds.
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