Metasaralgia, skiing and ski boots

[Smear]

Had new Lange ZB fitted in start of November after skiing for years in boots that was used well past their usable lifetime. Had to grind a bit at the little toe side on both feet, and even though it doesn't make sense that my feet should fit into the ZB based on how it looks and feels with just the footbed in, they worked really well. Had still some light pressure sideways on little toe side on the right foot, but not painful, so after 3 rounds of grinding I decided to just try. Skied ~3 times a week during most of November and Desember and in these first ~25 days of use the boots have felt reasonably comfortable and my feet seemed to tolerate well a bit of sideways pressure. And absolutely loved the performance they gave for skiing.

Now then came Christmas holiday with 8 days on snow in a row, a one day break and then 3 more consecutive days on snow after new year. Not in race boots all of the time, have a pair of more loose fitting scarpa hybrid AT boots with intuition liners and have used these on days with more work than pleasure. We just had a cold period with several days with -20 Celsius (-4 Farenheit). My feet kept warm in whatever boot using Lenz socks.

After this cold period my right foot has turned into a pain hell. Pain situated on the lateral side of the big toe metatarsal and also a bit on the medial side of the big toe metatarsal. My body just refuses to put itself in positions that put pressure on the foot, so my skiing turns completely shit and I really hate that...

Have had pain in this foot many times before and also not related to skiing or cycling. Last time this summer after a 80 km hike over 5 days wearing a heavy pack hiking mostly on boulder fields using stiff mountaineering boot. The pain took a couple of months to go away, but it did go away well before the ski season.

What to do?
-Grind more on ZB? But it worked really well for the first 25 days? Now everything is painful, even sneakers...
-Skip ZB and use a wide comfortable boot until the pain calms down? But even this is painful
-Footbed with metatarsal pad? does this work for skiing?
-amputation?

Have scheduled a appointment with my GP. Not really thinking that will help, he will probably suggest a break from skiing but that is not an appropriate suggestion until after about mid-april.

Have a good stash of tramadol and oxycodone and thinking to mix with paracetamol to make skiing more bearable. But perhaps not supposed to use those when driving back from the hill....

 

[Andy Mink]

Had new Lange ZB fitted in start of November after skiing for years in boots that was used well past their usable lifetime. Had to grind a bit at the little toe side on both feet, and even though it doesn't make sense that my feet should fit into the ZB based on how it looks and feels with just the footbed in, they worked really well. Had still some light pressure sideways on little toe side on the right foot, but not painful, so after 3 rounds of grinding I decided to just try. Skied ~3 times a week during most of November and Desember and in these first ~25 days of use the boots have felt reasonably comfortable and my feet seemed to tolerate well a bit of sideways pressure. And absolutely loved the performance they gave for skiing.

Now then came Christmas holiday with 8 days on snow in a row, a one day break and then 3 more consecutive days on snow after new year. Not in race boots all of the time, have a pair of more loose fitting scarpa hybrid AT boots with intuition liners and have used these on days with more work than pleasure. We just had a cold period with several days with -20 Celsius (-4 Farenheit). My feet kept warm in whatever boot using Lenz socks.

After this cold period my right foot has turned into a pain hell. Pain situated on the lateral side of the big toe metatarsal and also a bit on the medial side of the big toe metatarsal. My body just refuses to put itself in positions that put pressure on the foot, so my skiing turns completely shit and I really hate that...

Have had pain in this foot many times before and also not related to skiing or cycling. Last time this summer after a 80 km hike over 5 days wearing a heavy pack hiking mostly on boulder fields using stiff mountaineering boot. The pain took a couple of months to go away, but it did go away well before the ski season.

What to do?
-Grind more on ZB? But it worked really well for the first 25 days? Now everything is painful, even sneakers...
-Skip ZB and use a wide comfortable boot until the pain calms down? But even this is painful
-Footbed with metatarsal pad? does this work for skiing?
-amputation?

Have scheduled a appointment with my GP. Not really thinking that will help, he will probably suggest a break from skiing but that is not an appropriate suggestion until after about mid-april.

Have a good stash of tramadol and oxycodone and thinking to mix with paracetamol to make skiing more bearable. But perhaps not supposed to use those when driving back from the hill....

If you're going to your GP get checked for gout, just in case. A sudden flair up is no fun and it doesn't always get to the "get that feather off my toe" stage. A uric acid level test may be in your future.

 

[Smear]

Thanks for the tip about gout. Remember that diagnonsis from my biochemistry classes, but associated that more with huge malformations of the big toe, and not something that would look pretty normal and affect 2% of all people. Would make sence that cold feet on several days with -20 celsius could make the uric acid precipitate and cause trouble.

Just came back from the doctors office and he took blood samples to measure uric acid. He also sheduled an X-ray to rule out a stress fracture. If both these are negative he will propably send me further to a podiatrist or a chiropractor specializing in foot issues. Things take a bit of time when trying to deal with it using our public "free of charge" health system. But I'm too cheap and not desperate enough (yet....) to go all private. I guess my original post written in pain and frustration right after skiing sounded kind of desparate (amputation, opiates, what?!) so we will see ;-)

I have high arches. Espesially on the short (LLD) right foot that also have the painful big toe metatarsal, so that could also be a factor. But not clear what the fix for that would involve.

 

[Smear]

Skied 3 hours in powder today using the fairly tightfitting lange ZB's, and didn't even unbuckle during the 3 hours. In terms of foot pain this skiing part was the least painful part of the day, so thinking that the ski boot fitting way of dealing with this is a dead end.

Walking in winter boots very painful, sitting in office shoes kind of painful. Skiing powder, not painful at all, even without tramadol. But skiing choppy rutted ice last week in race track was not good.

Pain has kind of had two forms, either really painful, or just numb with no feeling of having a bit toe or big toe metatarsal. So guessing some kind of nerve pinging issue between the metatarsal heads?

The x-ray scheduled mid February and the doctor doesn't want to look at the blood sample for gout before 10 days after the X-ray. So to hell with public healthcare, and have scheduled an appointment with a private foot and ankle specialist in form of an extremity chiropractor tomorrow.

 

[Smear]

Managed to log into the lab doing the blood test so that I didn't have to wait for my slow GP. Normal uric acid levels, so it's not gout.

So went to the foot and ankle specialist for gait and foot analysis. He concluded that I have a plantar flexed first metastarsal/forefoot valgus and a dash of hallux valgus. During my gait I go down early on the big toe side, not rolling from little toe to big toe, and probably lack a bit of the pronation that is giving some of the shock absorption later in the gait. All of this is giving a lot of stress on the first metatarsal. Not used to this field so might have gotten things wrong, seems complex...

The fix is going to be some tissue manipulation, at home exercises and new fancy 400$ insoles with depression for the first metatarsal, good arch support, a met pad and some valgus correction. Hopefully this will give some relief to the first metatarsal.

He claimed that I could use same footbeds in almost all footware so them being expensive is not that bad. Well that is simply not true. Showed him my ski footbeds from the ZB, a 92 mm lasted boot in size 24.5 for a 25.5 foot. When you trim down these to fit the liner using the stock insole from the liner, they are a lot smaller than the foot. He seemed perplexed by the size of the footbed compared to my foot. It's kind of similar with an XC racing boot and road cycling shoes, but not as extreme, so one pair of foot bed will not get it done. Hoping to still use the footbeds I have for skiing and that using these new ones the rest of the time will give enough relief for the pain to go away.

When talking footbeds he came off a bit like a salesman yerk. Only their foot beds where any good, podiatrist orthotics not good, sidas customs not good, boot doc not good. Saw later that he must have managed to crack one of my expensive sidas while trying to prove that they were no good in a very disrespecful way. So not just a salesman yerk, but really an all over yerk... But have sheduled next appointment next week, so just swallowing that. I need this fixed. Can deal with the pain walking, but not with skiing like shit ;-)

 

[Andy Mink]

so it's not gout

That's good to hear. Check one annoying thing off the list.

 

[Smear]

so it's not gout.

That's good to hear. Check one annoying thing off the list.

Well not drinking beer, not eating meat or fish, just eating vegetables and drinking insane amounts of water doesn't sound much fun ;-) But not sure how easy this is to fix either.

 

[Andy Mink]

Well not drinking beer, not eating meat or fish, just eating vegetables and drinking insane amounts of water doesn't sound much fun ;-) But not sure how easy this is to fix either.

You can figure it out over a beer!

 

[Smear]

You can figure it out over a beer!

Well, keep thinking that if I were 8-10 kg lighter like I was 5 years ago, then my feet would have a better time. So perhaps a diet is in order even if it's not gout....

The week presented to the foot specialist/chiropractor:
Wednesday: 3h skiing pow in ZB, skiing was the least painful part of the day
Thursday: Rest day, or also called a long day at work
Friday: Skiing and setting up safety nets before a race, in wide comfy AT-boots, not much pain
Saturday: 2h classic xc. Feel skating would work better, but not much pain
Sunday: 3h skiing with my 12yo in soft conditions, ZB, not much pain
Monday: 4.5h skiing ending with 2h GS gate practice in challenging conditions, ZB. Skiing okish, but then pain hell broke loose when taking of the boots. Had trouble getting home, pain radiating out of the big toe more than underfoot. Thought the car broke down while driving up a hill on the way home, but it was just my foot that was not willing to step down on the gas pedal. Will try standing in the snow barefoot before driving home next time.

The foot specialist/chiropractor: The pain would probably go away if we modified your activity level, but we are not going to go there and try other stuff instead. I love the guy, he is no longer a jerk. But not sure I can handle many more days like Monday....

He did some joint manipulations to increase range of motion of pronation and dorsiflexion on the painful foot and some massage/tissue mobilisation.

Got some exercises to do at home; self massage and toe curling and toe spreading. The connection between my toes and my brain is not ideal. I keep sending signals to spread toes or individually curl or lift each toe, but it does not at all look like the impressive videos found on YouTube. A bit like skiing ;-)

 

[vtmecheng]

Having gone through 4 foot surgeries, lots of PT, and working with pedorthists…

1) Stop skiing until you know what is going on and have a plan to recovery. You don’t want to cause irreversible damage.

2) Find a doc (podiatrist or orthopedic foot and ankle surgeon) you trust. This is your life and you have one set of feet for it. The doc doesn’t have to be friendly or personable but shouldn’t be a jerk, dismissive, or make you feel dumb. Best docs are usually cocky though.

3) I have yet to have a good experience with a pedorthist, outside of a boot fitter. They are often over cocky and think their thing is the only thing. Worry about getting the right diagnosis first.

Good luck!

 

[Smear]

Thanks @vtmecheng. Foot issues suck since there is not much to do that's doesn't involve being on our feet. Have been reading about your issues and aouchh... Longing back to my shoulder issues...

Had 3 hours on skis yesterday. It was no fun and all pain when trying to edge the skis the slightest on the right big toe side, and landing jumps was not good either. Standing barefoot in the snow afterwards made getting home more bearable than on monday.

So taking a 4 days break from skiing. Lots of massage, rolling, stretching, exercises, ibuprofen gel and cold packs. Then try again gradually next week just sliding around and no gate training since that seems to set things off in the wrong direction.

I like my current foot specialist , even if a bit jerky, and going there twice a week at the moment. Will also continue on the GP-track with X-ray and see where that leads. Curios to see if the sesamoid bones are intact. Also like my boot fitter and will probably get him to grind some more sideways space in the forefoot, that can't hurt. But not sure either of them are the right person to cook up a foot bed for skiing to deal with this? The 400$ one from the foot specialist will be for everyday shoes, not cutting down those to fit into a plug boot ;-)

 

[Smear]

Had another visit to the ankle and foot/chiropractor yesterday. The magic 400$ footbeds from Canada that we are waiting does not have any forefoot valgus or rearfoot varus correction. He doesn't believe that I need any of that. Just a depression for the first metatarsal head, metatarsal pads and good support under the arch that hopefully will take some pressure of first metatarsal head.

Discussed if tight boot sideways in the forefoot could contribute to the issue, and he said that it was probably a good idea to make more space if they where very tight.

So scheduled a trip to the boot fitter the same day to make a bit more space in the ZB. It's on the little toe side they have most pressure, but it was for a reason that the last boot fitter didn't grind more after his 3 attempts. They are getting very thin, they have a flat section to not boot out before the buckles hit on the little toe side. Would have preferred more plastic for my needs... But he took of as much as he dared. He grinded through a similar boot the day before so he was feeling the pressure to not mess up this time. Didn't envy him that job...

On the footbed side we added boot docs met pads to the boot doc 3D race insoles. They insoles are very thin so not much to gain from trying to make a depression from grinding the footbed. Instead he ground a depression into the bootboard and also into the plastic of the boot under where the 1. metatarsal head would be to take pressure of it. Locating it with advanced lipstick technology. Has to work through the footbed and the liner floor but feelt this was a good idea and it didn't feel weird even with quite a large hole. The metatarsal pads on the other hand feel weird at first but most of that weird feeling does go away with time. I can deal with that weird feeling if it helps.

So taking a 4 days break from skiing.

Well that didn't work, ended up with a 1 day break. Had to try skiing since the boot fitter is located at a ski hill where I have season pass. It felt better but the foot is so inflamed that even everting the foot it in air at the chair lift is really painful. Hope the modification will make chances better for it not to get worse by skiing.

And waking up to this view from home this morning:

I'm thinking the chances for today being a rest day is quite slim as well... Perhaps I'll try a short xc-skating tour with met pads.

 

[vtmecheng]

All of this is how you end up with permanent foot damage, or a lost season at minimum. It takes weeks or even months for a foot to calm down and heal, not days. Take it easy and remember that a few times skiing aren’t worth permanent damage that could hinder skiing later in life.

 

[Smear]

It takes weeks or even months for a foot to calm down and heal, not days.

Thanks for the advice, and reading about it on the internet it does seem like you might be rights. 6 weeks of rest seems to be a common timeframe cited for rest for sesamoiditis which we suspect is the problem.

But my head will explode if I have to stay indoors doing nothing for months, weeks or even days... So trying to find activities that are not painful. There is snow everywhere so skiing is sort of the only activity that seems worth doing....

XC skating in soft conditions in flatish terrain worked without pain. Walking causes a lot more pain. If skating doesn't work anymore when the conditions get harder, I will switch to double poling on skating gear. If that doesn't work I will try to borrow a sit ski sled for XC... Hope it doesn't get to that, seems scary.

Here is how a Lange Z boot looks before grinding. Not that much plastic, mine is now really thin on the little toe side and also some grinding on the big toe side. We made a depression for the 1. metatarsal head in both the boot board and the plastic next to it as shown by the drawing. Hope it works, but first the inflammation needs to calm down...

 

[Zirbl]

You can push for the met heads, not just grind. Not unheard of to stretch a Z boot there.

The Z stiffens significantly below -10 and can feel narrower then.

Don't think many podiatrists know what a skiing footbed should be like if they're not into the sport themselves.

 

[Smear]

You can push for the met heads, not just grind. Not unheard of to stretch a Z boot there.

Yes, I guess you could. But you would then have to grind a good bit first to make it punchable. Then stop to grind before going to thin and stretch instead. The issue here was that it was already getting thin and would be sketchy to stretch. Glad I'm not a boot fitter... I do think I have enough width now.

Don't think many podiatrists know what a skiing footbed should be like if they're not into the sport themselves.

Jepp, had this discussion with the second boot fitter who also happen to be a chiropractor like the foot and ankle specialist. The "medical footbeds" will probably have much stiffer arch support. But that's probably going to hurt like hell under the arch when exposed to the forces of skiing. And make it hard to evert and invert the foot inside the ski boot for edging and rotary movements.

 

[SBrown]

Sesamoiditis sucks. I have one friend who actually had to have her sesamoids removed, not a fun surgery at all, so take care with yourself. I had it after my big toe joint replacement, but it went away after the next operation (fusion) since my toe wasn’t moving around anymore.

 

[Black Dog]

Managed to log into the lab doing the blood test so that I didn't have to wait for my slow GP. Normal uric acid levels, so it's not gout.

I have normal uric acid levels and I got a gout attack. My first was after 15 day of skiing in the Dolomites.
It kept flaring up until doc put me on Prednisone dose pack. It cleared it up fast.
A month later another attack (not skiing) he put me on Prednisone Pack & Allopurinol. Finally after a few months of mild reoccurrences it has not come back. Usually only happening in right big toe ball joint.
Ask for a dose pack and see it clears it up.

 

[François Pugh]

Just eat lots of sugar pie with maple syrup, pile on the french fries, candy, candy, candy, don't forget Pepsi to go with that. You'll get type 2 diabetes and your feet will go numb. You might have to deal with some balance issues though.

 

[vtmecheng]

Just eat lots of sugar pie with maple syrup, pile on the french fries, candy, candy, candy, don't forget Pepsi to go with that. You'll get type 2 diabetes and your feet will go numb. You might have to deal with some balance issues though.

Then there’s that whole amputation thing…