Once again, everyone is heading to the slopes. Skiing, both Alpine and Nordic, is one of the fastest growing spots in the country. With an increase in skiers also comes an increase in complaints about boot fit. Understanding the basics of both fitting will allow one to be more intelligent about whether the complaint is due to a functional foot problem or from a badly-fitting boot.

The components of a ski boot consists of a hard plastic outer shell and a soft inner boot of liner. The outer plastic shell is made of a heat moldable polyurethane that allows the foot and lower leg forces to be transmitted more efficiently to the ski.

The liner is a thick, sock-like, boot that encompasses the foot with a variety of heat-moldable foams. Normal body warmth will mold the liner around the bony protuberances of the skier's foot, giving protection to the foot from any painful compression against the hard, outer shell. The liner also consists of a thick, foam tongue that extends from the top of the foot to the top of the boot. This tongue acts as a preventive mechanism for shin discomfort when the lower leg is forced against it in hard and competitive skiing.

The skier with a wide foot usually has an enlargement of the heads of the first and fifth metatarsals, and he will complain of a burning sensation under the metatarsal heads. However,

the best way to create more room for the wide foot is to stretch the outer shell.

The skier with a narrow foot may have a problem with too much motion in the boot, which is easier to adjust. This problem is compensated by over-tightening the buckles. However, this may then place stress on the shell, which after a full day of skiing may create a pressure neuritis (nerve inflammation) to the top of the foot. By placing a thin felt foam pad between the foot bed and sole of the liner will resolve this problem, and will also take up extra space in the boot. The narrow-footed skier may also have some slippage in the heel seat. This can be helped by placing a doughnut-shaped pad around the inside and outside ankle bone to tighten the heel inside the boot.

Many of these pressure-irritation problems, as well as pronation problems can lead to injury which can be prevented by a properly designed ski orthotic foot device. The orthotic will create better stability and balance in the boot during edging and other movement, resulting in a more improved, efficient and painless skiing.

Dr. Robert F. Weiss is a sports podiatrist specializing in foot and ankle surgery, He was a member of the Medical Advisory Committee of the 1984 and 1988 Olympic Marathon Trials.

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