Dialing in balance, ramp and delta angles for fused ankle with almost zero ROM

[surfandski]

Some here know that I had my right ankle fused in April and it's really doing well and allowing me to get back to my active lifestyle with far less pain than before the fusion. My biggest challenge will be getting my boot/bindings/skis setup properly to put me in the best position for my extremely limited ROM.

I've done searches and read every thread I could find on ramp angles, delta, external shims, etc and have a somewhat decent understanding that I'll likely need substantial heal lifts, in an upright boot and then possibly shims under the heal binding to open up my ankle as much as possible. I've experimented with several pairs of boots this off season from 3 piece to boots with walk mode and it seems that I've come full circle back to my Lange RS 130s except for the fact that I will likely be wearing my 27.5 on my healthy left foot and a 28.5 on my fused right. Prior to my surgery, my right foot was already a half size larger and a VERY tight fit (I lost my toenail last season even after extensive boot work) and with multiple surgeries, my fused ankle is a much larger diameter do to all of the additional bone deposited during the healing process. The 28.5 on my right foot gives me more length, but also more instep room around that cankle yet a 28.5 on my left foot is way too big with 15ish mm shell fit.

I will absolutely be working with a boot fitter throughout the season to try to dial it in as good as possible so I won't ask you to go into great detail but I do have a few questions:

1. The 28.5 RS 130 have no heal lift yet as they are brand new and once buckled in I "hit the wall", meaning, I can hardly flex forward at all before it feels like forcing it forward (i.e. hitting a bump or G-out while skiing) would break my ankle where the ankle joint was. My 27.5 RS 130s have a 8mm heal lift and that makes a big difference to where I can flex forward a fair amount before hitting "the wall" and may be fine on smooth terrain but probably not enough if I hit a bump. So lets say I end up needing 15-20mm of heal lift to keep my ankle from hitting the wall which would be far too much for a normal ankle, what are the negative side effects?

2. Are the side effects reduced at all if say half of the increased lift is inside the boot (heal lift on zeppa) and the other is via a shim under the rear binding? The Fischer skis that I'll use for experimenting with before focusing on my all mountain and powder skis have bindings with very flat delta and can be shimmed.

3. Up until now, any heal lift changes (needed while skiing with almost no cartilage in the ankle) were made equally on both feet. If my right ankle needs an extreme amount of heal lift to keep it from getting injured, do I maybe split the difference and keep the 8mm heal lift in my healthy left boot and go higher on the bad one or do I want to have both sides the same? I've heard that you want them the same but yet last year I skied the whole season with about 60-70% of my body weight on my healthy leg because the pain was too much when I'd hit a bump in the ankle with no cartilage so I learned first hand that the 2 legs can act totally independently and our bodies are very good at compensating and relearning changes. In fact, I skied a lot of runs on just my left ski with my right ski up just to get a breather from the pain. So wouldn't I want that left boot setup properly regardless of what the right side requires?

4. Since I know that I'm going to be doing a lot of experimenting and likely trying out different height shims under my bindings, is it ok to loosen and tighten the screws multiple times as long as I'm not over tightening the screws or should I consider installing race plates or something on these skis for all of the experimentation I may be doing? I'm going to have to remount bindings anyway on the right ski since I'm going from 27.5 to 28.5 on that foot. Any specific shims or items (longer binding screws for sure) that I should pre-order just to make sure I have everything I need when I start my science project this winter?

Obviously, I'm going to be dealing with compromises where I may need more lift and sloppier fitting boots than what I'd prefer but it's my new normal and I'm going to be stoked even if I'm a total hack this season. Are there any other possible tweaks that could be tried for someone with an extreme circumstance like mine? Thanks for your help!

 

[Rod9301]

I think that the shims under the binding will not help you, but the ones in the boot under your heel will.

But a really stiff boot will help the most.

 

[cem]

Ok, not an easy one to give you both the precision you seem to be wanting and the space for the ankle, there are going to be compromises, but then again you are hopefully still going to be able to ski in a normal if perhaps slightly limited way

in no particular order

1 i would be looking at a PAIR of 28.5, 15mm is not "way too big as a shell check" its perfectly acceptable to most bootfitters and skiers. had you said 25mm then i would agree, but equally there are people out there who cannot tolerate less
2 heel lifts should be equal in height UNLESS you have been measured and diagnosed with a leg length discrepancy, you already have a fused ankle, using different height heel lifts is a good start towards back pain or a hip replacement, possibly a couple of mm won't cause a problem but each and every body has a differing tolerance to position
3 on the foot with the fusion a wrap around the back of the liner MIGHT help (by shunting you forward) decrease the effective forward lean of the boot which will make things more comfortable and reduce the loading on the forefoot
4 a custom liner is probably a good idea as it will take up some of the differences between the two feet and swallow up some of that massive 15mm shell check
5 pay attention to the size of your calf muscle at the top of the boot, anything above 14" circumference is going to push you forward and use up what little ROM you have, have the cuff stretched back to accommodate it

external binding lifts will change the position of you AND the boot, each case is individual but if you are struggling to apply pressure to the ski lifting the toe of the binding might be the answer rather than the heel, this brings the shaft of the boot and therefore your leg into a more vertical position needing less motion to apply pressure to the tip of the ski, without seeing you and how these things affect it is near impossible to say.

you have already started with the experiments, take your findings to a really good boot fitter who does alignment and work together with him/her to get the best solution, NOW is the time to do this before things hot up for the winter

good luck getting sorted and back on the hill

 

[otto]

Not to be contradictory or anything...

When there is limited mobility in the ankle joint, space is not your friend. You will want to attempt to deliver the most input to the ski with the least amount of joint travel. To do this, going to the smallest shell and expanding the tight spots a bit, will give you a better performance result on snow. So you sacrifice instep and ankle room to best "balance" the ankle joint for delivering power and ability to recenter the hips at the finish of every turn. Then you accommodate the instep/ankle space using your best practices of space making, either punching, grinding, or modifying the tongue thickness to get the fit to work.

On the same subject taking a skier with a fused ankle and "gas pedalling" the external sole, or raising the heel on the external sole borders on malpractice. Although truth be told, I see so much over prescribing of toe lifts from boot fitters, to ski instructors, to coaches, that it is painfully obvious that a huge chunk of the ski professional world has no idea where and when to externally elevate the boot toe or boot heel`. The answer is way closer to never, than the thousands of improperly prescribed toe lifts that end up in my store. Skiing is a sport that involves adaptation to the terrain and the surface the entire way down the mountain. Building "tricks" into the boot to "cast" or "fix" position of the foot, ankle, and lower leg, is not what we are trying to accomplish when fitting and balancing a ski boot. So stay away from artificially attempting to raise heel or toe when dealing with a fused ankle. Those accommodations should only be made inside the boot with the boot board and the forward lean of the shell. I will give voice to the possibility that you could radically set a boot up to rip on surfaces that are more similar to a billiard table then a chunk of forest service land. In those perfect conditions a boot could be "artificially" set up to arc and grip without fear of ever having to adapt the body position to a bump, slick or injected snow, poor grooming overlaps, etc...

Where I agree is that unless there is absolute evidence that there is an actual leg length discrepancy, all ankle joint mobility changes should be done bi-laterally, meaning that if you need a 5mm heel lift to get some mobility in the ankle joint of the left boot, you would add the same height heel lift to the right.

Also agree with as stiff a boot as possible with a fused ankle, so that transfer of power to the ski happens quickly and while the skier is relatively upright in their stance. A boot that has too soft a flex and too great a travel range, will never "bottom out" to the power transfer zone if the ankle range of motion is limited or locked out.

 

[cem]

@otto read the part where I say each case is individual none of us can tell what will Work for his individual without seeing and fully assessing the foot

When I was talking about gas pedalling I also mean very little, it will depend a lot on the binding delta in the first place, as you well know not all binding are created equal.

Also what would you propose on shell fit for this skier? His smaller un fused foot has 15mm does this not satisfy your criteria?

Just asking as you seem to imply that I am doing something wrong

 

[otto]

No beef with you Colin. My opinion is for the benefit of the op.

 

[surfandski]

Ok, not an easy one to give you both the precision you seem to be wanting and the space for the ankle, there are going to be compromises, but then again you are hopefully still going to be able to ski in a normal if perhaps slightly limited way

in no particular order

1 i would be looking at a PAIR of 28.5, 15mm is not "way too big as a shell check" its perfectly acceptable to most bootfitters and skiers. had you said 25mm then i would agree, but equally there are people out there who cannot tolerate less
2 heel lifts should be equal in height UNLESS you have been measured and diagnosed with a leg length discrepancy, you already have a fused ankle, using different height heel lifts is a good start towards back pain or a hip replacement, possibly a couple of mm won't cause a problem but each and every body has a differing tolerance to position
3 on the foot with the fusion a wrap around the back of the liner MIGHT help (by shunting you forward) decrease the effective forward lean of the boot which will make things more comfortable and reduce the loading on the forefoot
4 a custom liner is probably a good idea as it will take up some of the differences between the two feet and swallow up some of that massive 15mm shell check
5 pay attention to the size of your calf muscle at the top of the boot, anything above 14" circumference is going to push you forward and use up what little ROM you have, have the cuff stretched back to accommodate it

external binding lifts will change the position of you AND the boot, each case is individual but if you are struggling to apply pressure to the ski lifting the toe of the binding might be the answer rather than the heel, this brings the shaft of the boot and therefore your leg into a more vertical position needing less motion to apply pressure to the tip of the ski, without seeing you and how these things affect it is near impossible to say.

you have already started with the experiments, take your findings to a really good boot fitter who does alignment and work together with him/her to get the best solution, NOW is the time to do this before things hot up for the winter

good luck getting sorted and back on the hill

Sorry for not responding earlier but I've been on a camping/kayaking trip the past week and just got back to read this. Thank you very much for your reply as there is a lot of good info in here.

1. I used my 27.5 boots last year and it really fits right on my healthy left foot to the point where after the liners broke in, I felt like I needed them tighter and certainly wouldn't want them any bigger. I did buy 28.5 in the same boots and when I put them on my healthy/smaller left foot, it feels ok now but high enough volume that I could go out and ski them the first day without removing them and then be slipping around in them once the liners break in. So I'm sure I need the 28.5 on my injured ankle but feel the 27.5 is best on the healthy one. Later I'm going put my 27.5 Zipfits that I picked up this off season on my healthy foot and try that inside of the 28.5 shells and see if it takes up some of the volume because I do see the benefit of simplicity having the same size boots on both feet but given that I really have 2 different sized feet and ankles, I'm still feeling like one 27.5 and one 28.5 is my best bet.

2. That brings up a good point and I may luck out here because I think I lost about 4-7 mm when they ground out all of the cartilage in the joint so I should be able to keep close to the same heal lift on my healthy foot while being able to go the required higher amount on my bad ankle without it changing my height.

3. What do you mean by using a wrap around the back of the liner? Are you talking about one of those foam pieces that are used to take up volume or lock in a heal?

5. I always thought I had really skinny chicken calves and my injured calf has atrophied a fair amount since it doesn't get used as much due to the fusion. However, your 14" measurement seems small as my injured calf (with VERY little muscle left) is just over 14" (not enough to make a difference) and my healthy skinny calf is 15" exactly. So it sounds like I should be ok there as I haven't been using the rear spoilers on my boots.

Your comment about lifting the toe is interesting to me and seems counter intuitive to me at first because I think of it like putting my forefoot on top of a small book without a boot on which would reduce my ROM but I guess once inside the boot, I'm rotating the whole boot back (more vertical) without reducing my ROM. That will be left to the Boot fitter but at least I can keep it in mind to discuss when we start fine tuning things.

Thanks so much for your help!

 

[MRT]

Quote ( I always thought I had really skinny chicken calves and my injured calf has atrophied a fair amount since it doesn't get used as much due to the fusion. However, your 14" measurement seems small as my injured calf (with VERY little muscle left) is just over 14" (not enough to make a difference) and my healthy skinny calf is 15" exactly. So it sounds like I should be ok there as I haven't been using the rear spoilers on my boots.)

The 14 inch measurement quoted by CEM refers to measuring the circumference of the calf at the top of each liner.

So measure the circumference both calf muscles at the top of the liner and get back to us.

Your boot pushes your knee forward over your feet---the amount of push is affected by the circumference of each leg. If your legs are different, your knees will be asymmetrically pushed forward to 2 different positions. this will affect each of your turns and your fore/aft balance over each foot.

Mike
Bootfitter/Cped

 

[surfandski]

Quote ( I always thought I had really skinny chicken calves and my injured calf has atrophied a fair amount since it doesn't get used as much due to the fusion. However, your 14" measurement seems small as my injured calf (with VERY little muscle left) is just over 14" (not enough to make a difference) and my healthy skinny calf is 15" exactly. So it sounds like I should be ok there as I haven't been using the rear spoilers on my boots.)

The 14 inch measurement quoted by CEM refers to measuring the circumference of the calf at the top of each liner.

So measure the circumference both calf muscles at the top of the liner and get back to us.

Your boot pushes your knee forward over your feet---the amount of push is affected by the circumference of each leg. If your legs are different, your knees will be asymmetrically pushed forward to 2 different positions. this will affect each of your turns and your fore/aft balance over each foot.

Mike
Bootfitter/Cped

Yes, so about 14.125" on my injured ankle and 15" on my healthy one. I'm assuming the extra 1/8" above 14" shouldn't make too much difference on that ankle.

 

[MRT]

Yes, so about 14.125" on my injured ankle and 15" on my healthy one. I'm assuming the extra 1/8" above 14" shouldn't make too much difference on that ankle.

Your 15 inch calf muscle will push that knee about 8mm further forward than the other leg and cause you to have to sit back somewhat when that is you down hill leg. If you put a heel lift in both boots this will load the fore foot more on both feet (this will open the limited ankle, a good result, but) you will have to sit back more on both legs to get off of the front of the ski when you don't need to be there. the result will be tired quads.

Your boots will need less forward lean, (Langes typically have around 60mm of forward lean) To determine this measurement, stand your boots up with the heel of the shell touching a vertical surface and measure to the liner at the top of the back of the boot shell.

Your 15 inch calf needs about 46mm of forward lean in a size 27.5 (315mm BSL) boot shell to position your COM correctly over your foot.
Your other leg (14.125) needs 54mm, to accommodate the difference you could insert a spoiler of the correct thickness between the liner and boot shell to push this knee forward to align with the other leg. By the way, get the 27.5s modified to fit your larger ankle, a boot fitter should be able to do this, a boot seller will never be able to do this.

Adding a heel lift will change/affect the amount of forward lean needed to arrive at the correct Center of Mass Position (COMP)

This may seem link a commercial plug, but, the tool shown in the below address is capable of changing the forward lean of a pair of boot to accomplish what you need.
http://southernski.com/toe-jam-spreader-ultimate-cuff-stretcher.html

You have a lot going on in your fore/aft stance position, to the point that you will need someone trained in these issues to get a good result. We have seen people dance all around this issue and never finding a centered up position. My phone number is listed on our web site, if you would like to talk about what is needed or finding someone to help.

Mike

 

[surfandski]

Your 15 inch calf muscle will push that knee about 8mm further forward than the other leg and cause you to have to sit back somewhat when that is you down hill leg. If you put a heel lift in both boots this will load the fore foot more on both feet (this will open the limited ankle, a good result, but) you will have to sit back more on both legs to get off of the front of the ski when you don't need to be there. the result will be tired quads.

Your boots will need less forward lean, (Langes typically have around 60mm of forward lean) To determine this measurement, stand your boots up with the heel of the shell touching a vertical surface and measure to the liner at the top of the back of the boot shell.

Your 15 inch calf needs about 46mm of forward lean in a size 27.5 (315mm BSL) boot shell to position your COM correctly over your foot.
Your other leg (14.125) needs 54mm, to accommodate the difference you could insert a spoiler of the correct thickness between the liner and boot shell to push this knee forward to align with the other leg. By the way, get the 27.5s modified to fit your larger ankle, a boot fitter should be able to do this, a boot seller will never be able to do this.

Adding a heel lift will change/affect the amount of forward lean needed to arrive at the correct Center of Mass Position (COMP)

This may seem link a commercial plug, but, the tool shown in the below address is capable of changing the forward lean of a pair of boot to accomplish what you need.
http://southernski.com/toe-jam-spreader-ultimate-cuff-stretcher.html

You have a lot going on in your fore/aft stance position, to the point that you will need someone trained in these issues to get a good result. We have seen people dance all around this issue and never finding a centered up position. My phone number is listed on our web site, if you would like to talk about what is needed or finding someone to help.

Mike

Thank you so much for the detailed post Mike! I really appreciate it!

 

[surfandski]

One more question......after spending a good bit of time in my boots going back and forth between my 27.5 and 28.5 RS 130, I'm all but sure the 28.5 are going to be fine on both feet. The bindings I have on my skis have no adjustment in the toe piece so I can't move that without redrilling but the heal piece have a couple cm of fore/aft adjustment. On my 108 and 123mm waist skis, I've felt like I wanted the bindings mounted further back regardless so on those I happily slid the heal binding back and am fairly confident it's a move in the right direction. However, on my front side biased Fischer 86mm carving skis, I'm not sure how I'll like being mounted 5mm back (I think that's right if I'm only moving the heal piece 1cm back) or if I'll even be able to tell that much. I absolutely loved where they were mounted last season and they felt perfectly balanced. Now obviously I will try them with the heals slid back before remounting but IN GENERAL, assuming that Fischer's mark was indeed the "ideal" spot, what is the likely result of being slightly back on a non-powder, carving ski? Not enough weight on the tips to drive them?

Given that I'm going to likely need a substantial amount of heel lift for my bad ankle, does that counteract (help) or exacerbate the issue of having my bindings further back? One of the issues especially with my 108mm skis was that I often felt I was too forward on them (with a 8mm heal lift in last season) so if I'm likely going to a 15mm+ lift for my fused ankle, is my assumption that having my bindings slightly back will offset the additional lift? Or do I have this backwards in my mind? BTW- my bindings have almost zero delta with maybe +1mm at the most. Thanks!

 

[surfandski]

Rather than starting a new thread, I figured I'd ask a few more questions here since there is already a lot of great information here.

So last season I ended up skiing in the 28.5 RS 130s on both feet and to compensate for the difference in volume, I got Zipfit Garas and left all of the Omfit in the healthy left ankle to take up room and removed almost all of the Omfit in the fused right cankle to make some room. Because of my almost zero ROM on my right ankle, I ended up with a huge heel lift in that one (I'm guessing 15-20mm as I don't have them close by to check) and maybe 5mm less on my healthy ankle since my fused leg is now 4-5mm shorter. I really don't have a choice in reducing my heel lift much as any less and when I hit a bump, I risk over flexing my boots and breaking something. I did have a 4th surgery in April to remove all of my hardware and then skied 3 days at Squaw and had so much less pain lapping the bumps on KT-22 so I think I'm starting to get things sorted out, at least on firmer snow. I just ordered a pair of Proflex from Pulse Boot Lab and I think those are going to help a bunch so I'm excited to get those installed next week once I get back to my other house. They should hopefully make my RS 130s close to 150s or stiffer which should be great as at 195 lbs I feel like I overpower the 130s too easily.

So here's where I need help. Skiing with last year's setup was pretty darn good on groomers/spring corn and my body compensated really well for those big heel lifts to where you'd never know I had a fused ankle. A couple inches of powder wasn't bad either but as soon as it got deep like some 12-24" days on really steep terrain, my quads were absolutely screaming as those heel lifts had me so forward that I was having to literally push my body back as if doing a leg press the entire run. I had been averaging 6 days per week for the previous month and was in good shape but the powder was causing my legs to burn so bad that I couldn't even walk the next day even after 2 hours in the hot tubs in Glenwood Springs. My first day in deep powder I was thankfully on demo bindings so I was able to slide them back a couple inches from the recommended mount points to at least keep the tips up on my Liberty Origin 112s as they were submarines at the recommended mounting points. Clearly my lack of proper setup became more apparent in soft snow on my 108s, 112s and 125s.

The tall heel lifts are throwing me forward so what I'm wondering is if gas pedaling my skis would counteract that without closing the ankle or offsetting what my heel lifts need to do? I think I already hear someone typing, "go see a boot fitter" so let me say that I've talked to many of them and visited several and my situation isn't a simple fitting issue they've seen dozens of times so every one of them said, it's going to take a lot of experimenting so we can try various things but there is no clearly defined path for you. On this year's trip we'll be at a bunch of different resorts in various towns in CO, UT, MT and WY so I'm very open to suggestions for people who have worked with tough cases like my own. I still believe my case will require some art mixed with the science so it's probably going to take a fair bit of experimenting on my own to see how various tweaks effect things before taking that information back the experts (which I'm happy to do). One of the boot fitters I was working with was suggesting majorly modifying my Langes to make them even more upright but he wasn't convinced that would help so I didn't want to make major permanent modifications just to try something.

Wouldn't gas pedaling my bindings rotate my boot backwards essentially making them more upright and possibly putting me in a more balanced position? If so, where can I get 2mm, 3mm, 4mm etc shims so that I can place those on the toe pieces and experiment with this? Is there any formulas to use as a starting point like, 2mm gas pedal for 5mm heel lifts, 5mm for 15mm lifts, etc? Once I figure out what height is best, am I better off having a boot fitter gas pedal my boots or shim each of my 4 pairs of skis once I figure out each height? Unfortunately, only one of my pairs of skis has demo bindings and I think the mounting position is going to need a lot of experimenting as well unless the toe piece shims get me back to a normal stance where the recommended mount position works. I'm guessing that I'll need more of a gas pedal on my powder skis so maybe I end up with a small amount on my boots for my piste skis and then various additional ones on each of my skis. I obviously wouldn't mess with my own boots but I mount my own bindings so if you can steer me to where I can buy plates (or could I make some out of mylar or other material) and longer screws with the same thread, I'd probably be able to experiment with that part.

I'm not trying to take away from the expertise of any boot fitters and acknowledge that I don't have a fraction of the experience that they do so I'm really just trying to streamline the process by experimenting and then taking that info to them for the final setup. Thanks so much!

 

[surfandski]

Disregard my last post as I started a discussion in the Ski school forum more specific to my gas pedaling questions.

 

[Robert_Skis]

@surfandski This and your other posts on the topic have been very helpful! I have a couple of questions if you are still following the conversation.

1. How are you getting on with skiing two or three years post-op?
2. What have you settled on in terms of heel lift? How many mm? Inside the boot? Or, on the ski/binding?
3. What stiffness of boot have you settled on (I know it differs between brands)? Do you use a harder boot on your normal ankle and softer boot on your fused? Or, same stiffness?