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Stephen A. McDonald, C.

Ped
Jackson Hole Sports
Base of Bridger Gondola 1PM-Close, Tues-Sat

Please feel confident recommending your stronger skiers, high end clients and guests to:

Stephen A. McDonald, C. Ped


Board Certified Pedorthist Jackson Hole Sports Base of Bridger Gondola Excellence in Custom Ski Boot Fittings 307.739.2687
Bootfit and Custom Orthotic: $ 280.00 + Boot Bootfit Only: $100.00/hour + Boot (doesn't happen often) Bootwork by Stephen: $100 hour/ .5 hr/min. Contact me for Pro Price list- I'm here to help the working man. Making you look credible to people you send my way: Priceless Peak Season and high traffic times: 1 -2 day wait, AM appts. occasionally accepted

This information showing common ski boot problems may assist you in helping your clients... enjoy and pass the time accordingly. Good information is priceless. I hope you feel confident sending your guests w/ boot problems to me. Thanks! Stephen

Heel Pain In a medical environment heel pain is one of the most frequently seen problems for DPMs/Orthos and it's no different at the boot bench. Heel pain and skiing just seem to go together. Hard landings and rough conditions batter a (more) vulnerable (than you think) part of our body. For the skier and snowboarder, heel pain will come in three flavors. 1) Plantar Fasciitis 2) Heel Spur 3) Fat Pad Syndrome Remember: If you don't fit neatly into these categories see a MD/DPM/Ortho ASAP! Plantar Fasciitis Problem: (under the) Heel Pain, Strained Plantar Fascia, or history of Pantar Fasciitis. Usually this isn't the first time it has happened. Once the Plantar Fascia gets strained, you'll likely have problems with it for life. Prevention is key on this one! Who: Those with sedentary life styles are at most risk as the sudden increase in activity from a yearly ski trip causes this ubiquitous strain. Excessive pronation also is a contributing factor. Being overweight doesnt help. In extreme skiers and those pretending to be, a sudden strain from landing or jump (!!!) can cause plantar fasciitis. Likely injured in park and pipe with a solid, flat landing. Found in teens and athletic 12-16 year old girls. Solution: Heel Lift, Arch Support, Custom Orthotic, Rest, Vitamin I, Properly fit boots, see Stephen for stealthy skiing fix! ____________________________________________________ Heel Spur: This natural occurring and necessary tuberosity (bony prominence) on the front bottom of the calcaneus varies in length in some people. Seen in skiers and snowboarders who continually over flex their equipment. Caused by repeated boimechanical strain on the Achilles and under-the-foot muscles/ligaments. Simple and sometimes temporary orthotic modifications can bring a world of relief. Even though this condition is not usually acute (sudden onset), off loading the area through orthotic management can be obtained. Getting plantar fasciitis and heel spurs mixed up is a seriously painful experience. Proceed with caution and confidence.

You'd be surprised how many clinicians/bootfitters get these mixed up. Think of it this way:
Plantar Fasciitis Broad dull ache First step pain (AM) Pain from heel to toe Goes away with activity Torn/stressed/rupture of ligament Heel Spur Pin-point pain at front of Calcaneus Pain all day long (AM & PM) Deep pain Pain worsens with activity Aggravation due to lengthened calcaneal tuberosity

Plantar Fasciitis pain runs along the inside to middle of your foot, from the heel to just before your big toe. Heel Spur Pain should fit neatly under your thumb just in front of the bottom of your calcaneus.

I'm a Snowboarder, do I need Footbeds/Orthotics? You bet. The constant fore/aft rocking motion going heel to toe is more than most's people's arches can handle. The Plantar Fascia, the long ligament that runs under your foot, can be easily strained. Spending time in the park and pipe won't help either. I've often thought every snowboarder needs a custom footbed as much or more than most skiers. Snowboarding can be hard on your feet. Each year a bigger part of my business is snowboarders getting a custom footbed for additional control and comfort.

Fat Pad Syndrome: Problem: Hard landings can dislodge/shift the natural fat pad on the heel. Not always visible. Also comes from hard long hikes into the backcountry where the foot is shifting in the boot. Who and Where: This Plantar Pain is distinctly different from a heel spur as it feels like a dull soft bruise in the middle bottom of the heel. Remember Plantar Fasciitis and Heel Spurs are more anterior (front) of the heel and are palpable with slight point pressure. Seen in skiers taking long hard marches in heavy boots off the couch. The repeated pounding of the foot in a heavy ski boot in icy bootpack steps can shift the natural fat pad that cushions our feet. Thought to be accentuated by colder temps and thick socks increasing shear in boot. How to Fix: Get a custom orthotic to secure the foot in the boot. Reducing volume in the boot is key as the heel shifting and banging is causing the problem. Tighten up the heel to stop the banging. This can either be done with a custom orthotic with a higher heel flange or maybe padding the exterior heel of the ski boot liner.

Common Forefoot Pathologies What bootfitters hear: Ball of my foot is killing me, I feel a blow touch under my foot, nail through middle of foot... What it is: Neruomas- Pinched nerve from too tight a boot. 2nd Met Overload- Boimechanical errors from previous injuries can cause a second metatarsal overload. This especially occurs where Morton's Toe is present. When the second toe is longer than the first one, the second metatarsal accepts more pressure than it should creating a callus that can be painful in a tight boot. Metatarsalgia- general forefoot pain. Usually caused by a reduction in fat pat density under the metatarsal heads. You need arch support to lessen the tripod effect of the calcaneus, 5th met head and the 1st met head. Sesamoiditis- Two pea-sized bones under

the ball of your foot can become dislodged. It is pretty painful. I see it most in strong skiers who have to take a fast turn after a big jump. Arcing giant GS turns on Gros Ventre is another contributing factor. How it Happens: Large or wide feet get cramped into a narrow boot- pain ensues. It's a tough call- strong skiers and snowboarders need a narrow boot for control, but the narrow space in the forefoot pinches nerves that run between the metatarsal bones. Ouch. Solution: Thinner sock, check for wrinkles, reinsert insert/orthotic and/or replace it. Often a shift or wrinkle in the liner/footbed causes a change in volume. A skillfully placed met pad or a small neuroma pad will bring instant relief. Sometimes switching to a thinner sock will do the trick. Always think: Narrow boot, thick sock, age M/F and older women. Goes Away: Except for sesamoiditis, usually immediately.

Medial Ankle Pain Problem: Soreness/redness on the inside ankle. Sometimes it degenerates into bruising/blistering and broken skin. Likely the ski boot was never tight enough in the first place. How it happens: Putting the boot on properly so that the ankle is properly secured is key. When the medial foot structures are continually hammered by Jackson's steep terrain- beginner and intermediate skiers have to deal with this frequent hot spot. They're not used to the boot having to be that tight for adequate control- and that causes trouble. Repetitive microtrauma & neurocompression (!!!) are fancy terms for bruising and pinched nerves just above the medial ankle. Solution: This is where I look to tighten up the boot. Almost 100% of the time, a C-pad or other cut padding will help solve the problem. A custom footbed to secure foot in boot is essential. Sometimes a varus wedge is just what the skier is looking for. Depending on individual anatomy remove material from liner as necessary. The medial ankle is able to take considerably more pressure than the top of the foot and toes and responds well to padding to reduce bang. Modern ski boots are laterally stiffer and taller than their previous counterparts so it is important to make sure the ankle fit is SNUG.

Anterior Shin Pain Problem: Pain at step off or pain walking without ski boot (took it off at lunch), hurts when skiing, can't ski, bruising, bleeding. How it happens: Poor form or tail riding (!!!)- yeah you can't be afraid to say it. Wrinkles in sock or pants in boots can cause pressure points and muscle strains. Sedentary lifestyle/larger frame is a risk factor. Solution: Ski School for better form is a start. Get a thinner sock. A heel lift offers a slight change in biomechanics that will give the area relief. Make sure thermal underwear is not in the boot- the only thing in your boot should be your foot and a thin sock. An Eliminator Pad with a custom excavations over the problem area is key. Often a custom pad that is thin enough to pad/off load area but not thick enough to throw the skier into the back seat works.

Posterior Calf Pain I think Bootfitters see this less than before. With the advent of reverse camber and forefoot rocker skis, skiers are having an easier time staying balanced on the ski. The posterior calf pain I see is usually a compression injury. Sure on pow days I see tail riders, but mostly it's pinching boots on a large leg causing deep muscle bruising. Shows up as: Rear leg pain, especially where the boot tops out. Skiers and snowboarders often use the terms burning or throbbing.These leg muscles are in deep muscle compartment and bruise easily. After a good pow day, I talk with skiers who can barely walk. How it happens: Too much leg in boot- move the cuff ladders to get more circumference. Poor form or ability- tail riding, cankles, large calves, found in skiers with short wide feet & stocky frames, Occasionally I'll run across a strong skier that hammered the buckles for that big run and simply the boot boot cuff was too tight. Solution: thinner sock, heel lift (!!!), no pants in boot, properly fit boots.

The Cankle Problem: Hey, this is not just a woman's issue! We see 'em all the time, from the very young to the very old. To be polite, let's just say people are more chubby than they were just a decade ago. How it happens: Building from the above section, this is also a compression injury. I firmly believe it takes practice (and patience) to build up the muscles required to distribute ski boot pressure along the kinetic chain. Some people's muscles are softer and don't respond well to pressure in a ski boot. Being in a sedentary position on office days doesn't help either. All of this is compounded by a low tolerance for athletic pain. Solution: Wider boot, cuff. A heel lift is required to hopefully elevate the injured area from the pinch point. Moving the upper buckles to a wider position may allow addition banging, which can exacerbate the issue.

Less is more from the shin down. Let the boot liner/shell/custom insert do the work. Nothing but the sock should be in the boot.
Wool and Synthetic Sock Choice Warmth comes from the boot, not the sock. The thinner the sock, the greater the circulation. The warmer the foot. Stay away from padded socks. Ultrathin wool (Smartwool) and synthetic (Bridgedale) are all you should ever need with a proper boot fit. As the liner begins to pack out, padded socks work well to reduce volume. Be careful though, the thicker sock, the more likelihood shear (friction) will be introduced. I honestly believe more vacations get messed up because of poor sock choice. It is the gateway to all other problems in the boot.

The Angry Hard Charger Problem: Sore shins, sore ankles, poor performance due to painful boot. Too stiff a boot is making for a bad experience. Generally this guy will wait until his leg is going to fall off before going to see the Bootfitter.

How it happens: Piste-Off Skier who lives in an office like veal. Big bell-to-bell days early in the vacation have taken his body by storm. Solution: Get a custom cut shin pad or thicker Eliminator Pad for shin bang. Takes ten minutes @ JH Sports. Your guest needs a custom footbed to secure the foot in the boot.

Explain the Ten Day Rule You're skiing 10 days/year??? Buy Boots! You'll be happy! Without bringing comfort and performance into the conversation, buying boots just makes financial sense. After just a few days skiing per year, the cost of renting boots adds up. The comfort and performance of your own boot is what is all about. You'll never get that from a rental boot. Industry stats show that many skiers double the number of days they ski in a year after purchasing boots.

Notes on Properly Fit Boots

Boots that are too loose are not only dangerous (lack of control), they cause strain in the kinetic chain as the skier/snowboarder overcompensates with muscle actions. Muscles in flexion as can actually pinch nerves higher up the kinetic chain. The boot is your friend. Use it that way. Don't clench/grab with your toes. Let the footbed/orthotic do the work. The skier or snowboarder needs to be on the arch in a comfortable position. Grabbing with your toes for extra control doesn't work. Don't do it. Tell the skier to imagine relaxing the foot. The boot needs to be tight enough to relax the footbut not cramp or push with point pressure. It's a tough sell, selling the boot a touch tight- so that when the liner compacts it won't be too big! A custom orthotic greatly helps with this process as it secures your foot in an accurate position during the break in process. Very Important

Cold Feet

There is a direct correlation between dehydration and cold extremities (particularly feet)!!! Drink the water!!! Underling conditions such as Raynaud's Disease can cause cold feet. Boot heaters, like Hotronic and Thermic, help but can add extra weight to your set up. Get don't get boot heaters unless you have to.

Frequently a good skier/rider will come to me with foot pain. The boot work from home looks solid, the equipment is nice. Dehydration creeps up on Jackson Hole enthusiasts because of our dry environment. Muscle fatigue follows shortly there after. Encourage your guests to drink plenty of fluids. Also,drink good wine after skiing. But not too much- alcohol dries you out.

The $50 Boot Tune Up: Every skier needs a $50 Tune Up! It should be at the start of every vacation. Just a few simple steps will make your feet feel great. A little nip here, a little tuck there can change your guests' vacation. Recommend it- and come get one for your boots.

Gender Specific Fitting Issues Chronic Posterior Tibial Tendinitis- due to excessive pronation often seen in women's feet. Increasing weakness in the primary inverter in the foot. Shows up as a duckfooted over pronated stance. The incidence of bunions always has been reported as significantly higher in women versus men, with the implication that woman's shoes have a slow deforming effect on the forefoot. In this town I see as many bunions on men as in women. Stress Fractures- Lower bone density and potentially lower calcium intake compared with male athletes also may make the female athlete more susceptible to stress fracture. Forefoot & Met Issues: Women have wider a wider forefoot, plan on issues with stronger women who want a tight boot. Met pad in addition to custom orthotic is key. Also: Lower insertion point for Gastroc/Soleus complex means every woman's boot fit starts with a heel lift. No cankle? Slender leg? No bulging calf? Narrow ankle? Narrow Forefoot? Go right to the Men's wall and pick appropriate flex and foot shape.

Hyperhydrosis Some people sweat a lot. Be prepared to educate the guest they will need to pay attention to this. Feet have 250K seat glands and Solid skiers have extra liners & know frequently changing socks is key. A second set of liners on a ski vacation is invaluable. Changing socks at lunch is a ski trip saver! A warm foot is a dry foot. A dry foot is a happy foot. Look for sweat related pathologies- stank, white soft and/or peeling skin, discolored toe nails, blistering,seen in mountaineers and skinners. Hey Bro' Homeslice: Just washing your feet in the shower with soap can help control this issue. Foot stank chases the ladies AWAY! Nervousness or excitement can exacerbate the situation for many sufferers.

General Notes from

Sport Legs work- ask @ JH Sports base of Gondola. Cyclist have sworn by them for years. This natural supplement helps your body with lactic acid burn. It works. Try some and recommend them to you your guests. They'll go out of their way to thank you for it.

Stephen and JH Sports Bootfitters will make a footbed for any boot, $150.00- $300.00 will save your guest's vacation.

Beginners: Calf fit is better than foot fit. Experts: Foot Fit is better than calf fit.

Many boot problems are solved by the $50 punch or grind/$50 Boot Tune Up

For the Kids: Happy is better than fit. JH Sports has Junior Lange Boots in a variety of flexes.

-Take frequent breaks and eat all day long.

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