Boot canting or other advice for 13 y/o girl with hip problems.

Discussion in 'Ski Boot Discussion by America's Best Bootfitters' started by surfandski, Sep 13, 2017.

  1. surfandski

    surfandski Booting up Skier

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    My daughter started skiing last year and really enjoyed it and we are planning a 9 week ski trip to Colorado this year. Since as far back as we can remember my daughter would run with her knees together and feet kicking out to the side and when she mountain bikes her knees nearly rub the top tube when she pedals. When she started skiing last year she was a champ at snow plowing but as her skills improved we realized she has a really hard time running bases flat when skiing parallel. Her body naturally wants to place her on both inside edges. Certainly some of this is because she's still learning technique but I think a lot of it has to do with hips and legs. She was frank breach in the womb and her favorite position to sit in on the floor is with her femurs together and both lower legs out at a 90° angle. I can't even sit the way that is most natural and comfortable to her as it hurts me but Indian style hurts her.

    We figured she was knock kneed but we took her to an orthopedic specialist and he said no, she has congenital bilateral femoral anteversion which basically means her femurs are rotated forward/in in her hip sockets causing bursitis. When asked if physical therapy could fix this he said no, the only thing that could was a surgery where they cut the femurs and rotate the bone out/back and then put a rod in. We don't want to go down that road nor did he recommend this.

    When asked about skiing, the Dr who is in Florida and likely has zero experience with mountain sports medicine said forget about skiing and have her snowboard instead. I'm not opposed to teaching her to snowboard since I did it for years but we are all geared up and the plan is for our family to all ski this extended ski trip. It would be hard to give her snowboard lessons and my wife and son ski lessons at the same time and to be honest, I'm burned out on snowboarding so I didn't even plan to bring one on this trip.

    So does it sound like a good boot fitter will be able to help her out thru canting or wedging the soles of her boots? I just bought her a pair of Head Raptors with dual "canting" adjustment as they seemed to have the most adjustment of boots that fit her. I realize I will get the rubber stamp "take her to a boot fitter" advice but that isn't easy where we live. I have a great boot fitter in Breck that I will take her to when we get out there but if it sounds like her issue is bigger than what a boot adjustment could handle, we may need to rethink our plan. The family days will be low-key, just have fun, days so I'm not going to be pushing her but I want her to be comfortable and not in pain the whole time. I'm thinking about having her clip into her skis and playing with the canting to see if she feels a difference in the living room. Any advice or suggestions?

    Thanks and sorry this went so long!
     
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  2. markojp

    markojp mtn rep for the gear on my feet Industry Insider Instructor

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    I don't think there's a fitter out there that is going to fundimentally change your daughter's issues, and I doubt that anyone qualified has their MD., but there are orthopedic docs that specialize sports medicine, and some even know their skiing. Finding one of those would probably be your first, best option IMHO.

    And has been often said, boot cuff alignment isn't 'canting'. Careful with that one. The distinction's important.
     
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  3. surfandski

    surfandski Booting up Skier

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    Agreed, that's why I put canting in quotes because it's not correct, but it's a term even the boot companies use.
     
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  4. Tricia

    Tricia The Velvet Hammer Admin Pugski Ski Tester

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    Sounds like you've got your work cut out for you, but mostly you need to take her to a fitter who is also has a c-ped.
    If you're planning on seeing a fitter on your trip to Colorado, I'd plan a solid day to see a qualified fitter. Try Bob Egeland at Boulder Orthotics http://www.boulderorthotics.com
    or Greg Hoffman at Ski Boot Fitting.(BeaverCreek) https://www.facebook.com/Ski-Boot-Fitting-Inc-60583101525/?pnref=lhc

    ^^^ This - What some think is canting on a ski boot is actually cuff alignment.
     
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  5. BGreen

    BGreen Getting on the lift Skier

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    There is a significant difference between a bootfitter and an alignment specialist. I have met only two people who are good at both. Even the best alignment specialist has a very rudimentary understanding of the human body compared with an orthopedist or someone who is looking at bone, muscle and tendon structures daily.
     
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  6. Muleski

    Muleski Making fresh tracks Industry Insider

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    Did I read that correctly, nine week ski trip to CO? The reason that I ask is that it might open up a couple of things. I'm not an MD. I'm an older guy who's been hanging around this sport, others, and a lot of docs for decades. We have two ladies in our family who had very significant reconstructive surgery as late teens, ending competitive college sports careers, but now all "good to go" at anything as adults. Seriously, anything.

    I think that we can guess, even with some informed guessing. I agree with @Trish and @markojp that you need to pay attention to this, and perhaps, perhaps a boot fitter can be of help, for this trip.

    You probably know this, but the Vail Valley is pretty much the epicenter for orthopedists who specialize is ski related injuries and challenges. Docs who ski, have ski raced, support many of the world's best skiers etc. Google "Marc Phillipon, MD." Marc is the Managing Partner of the Steadman clinic, and his specialty is hips. He is the man, in the eyes of many.

    Might be worth a day out of the nine weeks, up front to have a consultation......obviously having had a dialog well before. You daughter might also think that it's a pretty cool place to visit. Lots of cool pictures of patients, etc.

    I have a suspicion that while he might confirm everything that you already know, he might have a suggestion or two on how to set her up and accommodate things right now. He might also send you right over to a boot guy, or two in the Valley. Or in Breck.

    One guy's opinion. Since you will be there. Sorry for sticking my big nose into your family's business.

    Best of luck to you all. Nine weeks. Riding a board could be fun....might fully push her to the "dark side!"

    Edit: Just saw @BGreen's post. Good points, good advice.
     
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  7. Tricia

    Tricia The Velvet Hammer Admin Pugski Ski Tester

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    This is why I recommended two people in Colorado who have their C-Ped. They will recognize the bigger physiology issues and either help, or recommend medical attention.
     
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  8. fatbob

    fatbob Out on the slopes Skier

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    I used to sit like that when I was a pre- teen and would very definitely run knock knee'd. Somewhere it sorted itself out and in fact my main alignment issue is being slightly duck.

    A good tech might be able to achieve something with shimming bindings in which case Doug Briggs is likely your guy.
     
  9. razie

    razie CSCF Coach aka Sir Shiftsalot Skier

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    yeah... girls are generally more likely to be knock-kneed and a few things can be done to address it.

    First, like @markojp said, cuff alignment, which is what the dual knobs on the Raptors do, is not the same as canting. It's purpose is to make sure the cuff follows the leg and it's the first adjustment to do.

    Canting is changing the angle of the sole of the boot, by grinding it and/or shimming it. This is the stuff that I use for myself/kids/athletes: http://www.cantco.net/CantCo_Ordering.html

    Canting is a fairly involved process, so you're best to leave it to experts. However, while it is pretty easy (with the right tools and knowledge) to statically align someone within 20% or so, meaning addressing 80% of the issues, it is equally easy to find some wannabe "boot dudes" to muck it up for you.

    Also, for her, footbeds may certainly be something to look into.

    You can improve her situation a lot. Been there, done that. Here's a few shots to make the point:

    cuff alignment (they also have canting shims - see the black on the sole. left is factory default, right is custom aligned and canted )
    [​IMG]

    look at the radically different angles the skis are at, when this skier thinks they're "flat".
    [​IMG]

    and we're only talking lateral alingment of the boots.... fore/aft alignment is another issue...

    However, addressing it as much as you can will simply change her skiing. Don't be surprised to see an "overnight" leap... in not only her skiing, but also, her enjoyment of it.

    cheers
     
    Last edited: Sep 13, 2017
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  10. surfandski

    surfandski Booting up Skier

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    Thanks everyone! That is a lot of great information and I will definitely try to find one of those good boot fitters and appreciate the recommendations here. That picture is very similar to her position so when I say bases flat, she's like Dad, my bases are flat. Like the pic, it's the knees naturally coming together rotating one or both of the skis towards the inside edge. When she manually separates her knees the bases go flat but that's not natural.

    Just to clarify, her issue isn't so major to where it's debilitating in any way. If you met her you'd never suspect she had any sort of issue if you saw her standing or walking down the road and in the pool she's as graceful as can be. It's certain activities where you quickly notice something isn't lined up right, skiing being one of them.

    As an experiment tonight, I maxed out the cuff alignment of her boots and had her clip into her skis and it does help her get her bases flatter but I think she'll need more than that so I will definitely make an appointment so I can get her in with an alignment specialist as soon as we get to CO. @Tricia what exactly is a C-Ped?

    I've heard of the Steadman clinic and would love to get my daughter in there but I'm almost positive our insurance won't cover that as they pretty much don't cover anything out of state unless it's an emergency and we go to an emergency room first who then sends us to a specialist. It's rough being in Florida where it's just so hard to find a Dr who is knowledgeable about the mechanics of skiing, etc. Heck, I'd love to go to the Steadman clinic because I'm going to likely need an ankle fused next year and I'd love to have someone do it who understands sports injuries and can give me the best chance of continuing in some/all of my activities.

    I really appreciate all your help!
     
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  11. Philpug

    Philpug The Ski'er Admin Pugski Ski Tester

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    Certified Pedorthist- A pedorthist is a professional who has specialized training to modify footwear and employ supportive devices to address conditions which affect the feet and lower limbs.

    The guideline here will be to accommodate her, not correct her.
     
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  12. L&AirC

    L&AirC PSIA Instructor and USSA Coach Skier

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    Some of the best bootfitters have both titles; CPED and bootfitter. The one I go to does and he's amazing. There are amazing ones that aren't CPEDs as well, but a little more difficult to find.

    IIRC, one of the first things they do is make sure the ankle is neutral and then work from there to get the skis flat. This is also why they start with making a foot bed.

    My daughter had a similar issue when she was younger with regards to getting her skis flat. Her issue stemmed from her being hyper flexible which means her arch collapses anytime it is weighted. This rolls her ankles inboard and when she skied, she was in an A frame (on both inside edges at the same time even with skis parallel). The boot fitter gave her custom made foot beds, changed the cuff alignment, and shims on the boot sole (canting).

    She instantly went from a wide A frame to skiing more upright with her feet much closer together. She had been A framing as it was the only position that didn't hurt her ankles. She could now ski all day long pain free and her skill level increased by just putting the boots on.

    To Phil's comment about the CPED accommodating and not correcting is spot on. It's been almost a decade since her first pair of properly fitted boots and she is still hyper flexible and her arches still collapse when weighted. She will also tell you her most comfortable shoes are her ski boots.

    It is amazing what a bootfitter can do, especially when they have a strong understanding of how we're put together.

    The good news for you is she is 13 and very close to her shoe size not changing anymore if she isn't already there. This endeavor isn't cheap and I had to go through it with my daughter 4 times. She was 15 or 16 when she got the last pair of boots (this was more to upgrade the boots than the fit) so she should be good for quite some time.

    Ken
     
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  13. Uncle-A

    Uncle-A Out on the slopes Skier

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    Who is your CPED Boot Fitter? I am always looking for a good resource in the Northeast and since your location is listed as Southern NH (New Hampshire) he would be accessible when I get up that way.
     
  14. L&AirC

    L&AirC PSIA Instructor and USSA Coach Skier

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    Bill Haight of Green Mountain Orthotics Lab (GMOL) but he is in VT at Bromley. It's just under a 3 hour drive for me but worth it.
     
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  15. PTskier

    PTskier Putting on skis Skier

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    Harald Harb and Diana Rogers at the Harb Alignment Center in Dumont, CO (just east of the Eisenhower tunnel), along with Bob Hintermeister, PhD biomechanist, presented a paper on skier alignment at the 2nd International Congress of Science and Skiing in 2000.
    "Harb, H.R., Rogers, D., and Hintermeister, R.A. (2000). Improved Skiing Performance Through Alignment And Equipment Optimization. 2nd International Congress on Science and Skiing, January 2000, St. Christoph, Austria, Book of Abstracts, p. 154-155."

    Surfy, I'd email their shop with the specifics about your daughter's condition and see if they have any suggestions for her. I trust them, and if they say that there is nothing to be done for her condition, I'd believe them. If there is something they can do, it's an easy drive from Summit County. Make a appointment first.
    https://harbskisystems.com/pages/contact-us
    https://harbskisystems.com/pages/skier-alignment
    https://harbskisystems.com/collections/harb-ski-camps/products/171023-alignment-technician-training

    You can try DIY. At home put her into the boots, use a carpenter's square or a plumb bob, and try putting wedges under one side of each boot until her knee is centered over her foot. See if she feels OK and if she can flex up and down. That would be a great step. If it causes pain or she just can't move, I think you'll see the answer for yourself. If she's OK when aligned, then a pro can likely get her set up correctly.
    [​IMG]
    [​IMG]
     
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  16. surfandski

    surfandski Booting up Skier

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    That's really encouraging Ken, thank you! And thanks to everyone else who has contributed here! The biggest challenge is skiing is new enough to her that we don't know yet if she will LOVE it so this 9 week trip is kind of a test for the whole family. I grew up in Tahoe and always planned to teach the kids to ski and then realizing an ankle fusion was imminent after an injury 2 years ago, we started them skiing last year and they both enjoyed it with my 8 y/o son getting totally hooked and absolutely ripping for how few days he's skied. So if this extended ski trip goes well, and I figure out how to ski with a fused ankle, this may be an annual journey where we pick a different location to spend 8-12 weeks. Or it could end up that my wife and daughter are like, "that was fun but not something we want to do all that much" and my son and I end up being the main skiers. In that case, I'd hate to spend a fortune on her if we realize at the end of this trip that it's not for her moving forward. We just won't know until this trip.

    It's a catch 22 because we are investing a lot in this trip and I want her to be comfortable and have the best chance of success but also realize her feet are still growing (thank God she hasn't grown out of the new Raptors I got this spring because she's already on the tall side of her new Volkl RTMs that she's never used) and she's doesn't have the skiing experience to understand what "assume your normal stance" at a bootfitter is. Knowing that the first day I'm going to take each of them out for a short lesson one at a time to get them comfortable again, I'm wondering if I should do that first so it's not so foreign when we see a fitter/C-Ped or if I should get her aligned first. I don't want her in pain but keep in mind I may only have her ski an hour or so the first day anyway since her quads are about as big as an average guys calf (seriously, she's 5'6" but with legs like a giraffe) so she's going to be feeling the burn no matter what.

    BTW- for you coaches out there, are there some specific exercises or videos you'd recommend to help condition her hips and legs to prepare her? We are doing this
    about once a week but I'm sure there are specific strengthening exercises that would help her condition. Again, not many PT with ski experience here in Florida.

    Thanks again!
     
  17. surfandski

    surfandski Booting up Skier

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    Thanks PT skier! Your post came in while I was typing and more great info there!
     
  18. Uncle-A

    Uncle-A Out on the slopes Skier

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    There use to be a machine for measuring the size of a cant wedge to place under the binding. I do not remember the name or manufacture but the customer would stand on these two plates(like they are standing skis) that rocked back and forth as the skier mover their knees side to side simulating a turning motion. The plates had three lights connected to the left and three lights connected to the right of each plate. After the customer would shift their knees left and right a few times they were told to stand as if they were skiing straight and the lights would indicate if they need 1, 2, or 3 cant and which side to put the high side of the cant. It also came with interlocking wedges that you would place on the plates to show that when the cant is in place it would it would level the plates like a cant would make the ski flat on the snow. It was easy to use and quite accurate and you could do it your self. I wonder if any of those machines survived till now.
     
  19. L&AirC

    L&AirC PSIA Instructor and USSA Coach Skier

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    She (you) has a better chance of liking into if you go to the boot fitter first for a couple reasons:

    1) she won't be in pain so the experience will be more enjoyable

    2) any movements she learns will have to be relearned when her stance is corrected.

    There is also a chance she will be more willing to stick at it longer when she sees how much you, and to some extent she, puts into it.

    Best of luck,

    Ken
     
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