Since it is impossible to determine what is right for a particular skier over the Internet, I would not attempt to do so.
It is worth clarifying what some of the modifications being discussed actually do.
Heel lifts decrease the amount of ankle flexion within the boot. They do not pitch you forward. The only time we heel lift (increase internal ramp angle) is in the case of limited dorsiflexion. Increasing ramp angle does not change knee flexion, it simply reduces ankle flexion inside the boot. This can lead to breaking at the waist. When measured digitally on a force plate people with limited dorsiflexion stand with an excess of weight on the ball of foot when in ski boots. A heel lift increases contact at the heel and actually takes weight off the ball and redistributes pressure to the rear foot. Again this is with limited dorsiflexion.
External toe lift (gas pedal) decreases knee flexion without changing ankle flexion. This tends to make the femur more vertical and moves the hips forward. We only toe lift boots if the skier has excessive knee flexion in a particular boot.
An internal heel lift and an external toe lift do two different things. One decreases ankle flex, the other decreases knee flexion.
They do not negate each other.
Ankles that are surgically fused are normally plantarflexed a couple of degrees, so you would select a boot that is as upright as possible and stiffer is better than softer. An increase in internal ramp angle would also be indicated. Keeping contact with the shin is very important so that whatever forward motion can be generated gets to the ski as soon as possible, since there isn't go to be very much.
Unfortunately none of this has taken into account the binding angle yet. This is why if I were in charge all bindings would be flat or easily adjustable. Because binding ramp varies with model and sole length it is a difficult variable. Not everyone has all the same bindings on all their skis.
Fore/aft balance is a very important aspect of ski boot set up and becomes more important as rom decreases.
pliny the elder
Nominated for "post of the month".