Bootfitters: Instep pressure point (navicular bone)

[LC]

Question for the bootfitters: best way to take pressure off a navicular bone growth?

My right foot has had a growing bone lump on the navicular right where the second lowest buckle falls for the last 4-5 years. It never really bothered me until this winter, I could always feel it but it wasn't painful but it's definitely getting more pronounced now, gives me a bit of pain when flexing hard (with lower buckles just barely latched) and if I keep ignoring it it's going to get even worse. The boots (Falcons) fit otherwise awesome.

I have some bootfitting experience myself in the past but just looking for tips. I don't think grinding the bootboard lower is an option (don't have a flatbed grinder and neither does my local shop). I've seen guys I worked with cut a circle out of the liner tongue plastic over that area - is that the way to go? Or padding around it somehow (where?) or removing liner foam?

[mntlion]

donut pad around the pressure point on the liner,

grind a small hole for the nav bone on the shell (just MAKE sure that it is the right place)

check your footbeds for more/less support.

[sar13]

Not to contradict Mntlion but I would put his answers in reverse order.
Check your custom foot beds first. You don't have customs? You need them.

If someone with a ton of experience has looked at your beds and your feet and said they are as good as can be and that you wouldn't benefit from a varus wedge, then do some grinding/padding in the liner. I'd start by cutting a criss/cross pattern into the outside of the liner in the right spot and add padding around the bone if needed

[LC]

Thanks guys. Yes, I have custom footbeds in there. If anything they've got slightly too little support for my foot (high arch but stable foot). An experienced fitter in Whistler cast them and I ground them under his supervision, leaving a lot of support initially but that killed my foot so we took a little away. I could understand that having too much arch support might force that area upwards but too little...?

Cutting/grinding the outside of the liner (the plastic part on the lower tongue) was what I was thinking; either cutting a hole in the plastic entirely or thinning it down a lot with a dremel so it can flex up, I guess crisscross cuts would do that pretty well like you said. Or how about slitting the liner from the outside and removing foam from the one small area? Would the foam just migrate to fill the gap anyway if I did that or would the gap formed remain as a little pocket for the bone to poke up into?

About padding around the bone: where would I stick the foam? On the outside of the lower tongue (on the plastic part under the stretchy instep thing)? That would be tempting to try first seeing as it's reversible.

Any more suggestions welcome. Thanks.

[sfotex]

I've got something similar going on on my medial cuneiform I think. One thing I noticed is the wrap intuition liners in my at boots don't irritate it compared to the liners I have with tongues. Don't know if it's the same with you, but all the seams in the tongue liner seem to come together in the wrong place and put pressure on the bone spur vs. the wrap liner.

I'm probably just going to see the doctor and see about getting my bone spur ground down, I think it's going to be the long term solution.

[weasel1]

Or how about slitting the liner from the outside and removing foam from the one small area? Would the foam just migrate to fill the gap anyway if I did that or would the gap formed remain as a little pocket for the bone to poke up into?

The foam should stay put, so if you remove it in the problem area that should help.

About padding around the bone: where would I stick the foam? On the outside of the lower tongue (on the plastic part under the stretchy instep thing)? That would be tempting to try first seeing as it's reversible.

Would need to be next to your foot, not outside on the plastic of the tongue. You can tape it on the liner, try it, then if it helps, get all surgical on the liner. I have often removed the stitching on one side of the tongue, excavated or shaped the foam like I want, then stitched the tongue back together.

Two other things: first, most custom footbeds do not allow for the fifth met to drop as it wants to during the mid-stride motion that is boot flex. I have had some luck thinning a section of the outside of a custom footbed to increase flex in this area like the ALINE footbed allows for. Then again, an ALINE bed is $50, so might behoove you to try one of those before you grind your footbed. Second, an intuition liner would likely solve this issue nicely, along with many others.

Just in case you couldn't tell, I am a fan of Intuition liners and ALINE beds, though not sponsored or otherwise affiliated with either company.

My $.02

[LC]

Really? If I glued foam to the inside of that area I really don't see it lasting more than a few weeks before it's dislodged, especially if I was to put boot + liner on as one unit. I'll grab some foam and try a few things here, see what works and what doesn't.

In terms of the footbed I don't see how the 5th met dropping lower would affect the position of the navicular which is in line with the 1st met.

[weasel1]

Really? If I glued foam to the inside of that area I really don't see it lasting more than a few weeks before it's dislodged, especially if I was to put boot + liner on as one unit. I'll grab some foam and try a few things here, see what works and what doesn't.

No, you're right, gluing it to the tongue will not work. When you have the right position, you will want to get surgical on the tongue. Slit the threads holding the fabric to the plastic so you can get in under the fabric, slide in your donut, and position it where you want it. Some contact cement will help keep it in place, but it will be messy, and you will only get one shot. Once the pad is in place, you can stitch the liner back up.

In terms of the footbed I don't see how the 5th met dropping lower would affect the position of the navicular which is in line with the 1st met.

High school physics- equal and opposite reaction. If the 5th met can't drop, the foot is force inward to a pronated position, pushing the navicular against the shell. No part of the foot moves in isolation. Movement in one area, or lack of movement, affects other areas as well. This doesn't always solve navicular pressure issues, but it can significantly affect it. Like I said, try a bed that allows for this movement to see if it helps before grinding away at your custom bed. You should be able to tell in the store if it helps at all.

Mtnlion can tell you if I am out in left field here, but these (in addition to the plastic thinning/removal) have been effective my experience.

[mntlion]

I can only guess too, only YOUR feet can tell us what is right (fucking yoda of boot fitters)

but everyone is making good guesses...

[Lloyd Braun]

I had the same problem, with the same boot. the Falcon 10. Anyway my bootfitter dug out the padding in the tongue and sewed it back up. Problem solved.

[LC]

OK thanks guys. Lots of options. Will see what my shops says too.

[skiing-in-jackson]

Like most things in life, it really boils down to two flavors...

In this case, Accomodative or Functional?

Footwear modifications come in two flavors. (We'll just be thinking all the time that our ski boots are really super fancy pieces of footwear.)

If you have an Rx from a DPM or MD requesting footwear/orthotic modification, usually they'll state if the fix should be an accomodative or functional one. Sometimes they don't say at all, letting the C. Ped make the decision.

When you accommodate a foot, you modify the footwear to fit the foot and whatever position it may be in at the time. Frequently bootfitters will accommodate a fit problem by grinding and stretching. Modifying the liner is an excellent example of an accomodative fix. Cutting the edge of the sole material that is bonded to the side of the liner is another. Spaghetti slicing the liner is yet one more. Not too many ski orthotics are accomodative unless there is an underlying medical condition to begin with.

When you use a functional fix, you are using the footware to change the position (control the function of) the foot- many ski orthotics are functional in nature and attempt to correct to subtalor nuetral as best as the user can handle without being too painful during the break-in process. Eversion/inversion problems are functional when they are fixed with wedges.

So BamBam here has a goiter growing on the side of his foot. Removing material from the liner will accommodate the problem and making sure the footbed is solid and supporting the foot properly would be the start of a functional fix.

Not having seen this guy's foot, I'd try to wedge his foot a little to see if that gives him some space. I am a renewed fan of stock liners- well... nice ones- and look at other fixes before tearing into the liner. Once you start removing material from the liner, structural, support or temperature issues can be encountered. That said, if I can slice up a liner and fix a problem that's a no brainer.

The only thing that really stands out to me, is you mentioned your navicular prominence has been growing. Lots of times, the body is responding to pressure and can calcify an area looking to protect it- your bump grows. If you accommodate the fix, you may just give it room to enlarge again, but if you opt for a functional fix, you may nip the problem in the bud.

[steved]

$.01,
As mentioned...grind from inside..(match up with grinding over the top of tongue's plastic), add foam, maybe a little heel lift to change angle/draw it back(trash idea if already have some). Info from Ped man(above) also...

[Beder]

I am a renewed fan of stock liners- well... nice ones-

I would like to hear more about this from you--maybe in a new thread so as not to hijack this one. After 3 100+ day seasons in various Intuitions I am done with them.

[skiing-in-jackson]

...as not to hijack this one...

/hijack alert

Intuitions are great and I mold them all the time, but far too many skiers charge into them too quickly. Stock liners have gotten very nice in the past 4-6 years. I'm very pleased with the quality of Salomon and Garmont (non thermal mold ones) in partcular.

IMHO, stock liners are much easier to modify when needed.

[LC]

Sounds a pretty valid point that taking pressure off the bone will be a temporary solution and allow the bump to grow more. Like I said, I've felt this bump for the last few years but it was easy to put up with, now it's grown to the point it's a little uncomfortable when flexing hard. I'm sure I'll be able to take pressue off at least temporarily to get back to the comfort I had 2-3 years ago but things could well become worse again. So I'll need to figure out the best plan, show someone else the foot/boot/footbed and so on.

When wedges have been mentioned, are you talking heel wedge/lift or lateral wedge (varus/valgus, I forget which is which)? I tried the Falcon heel lifts (about 2mm) just to see if changing the position affected anything and they put noticeably more pressure on the bone even without the lower buckles fastened.

The Salomon "CF Race" liner that's in these just now is one of the nicest I've seen in any boots off the shelf, and is pretty thin and firm. I wouldn't be sure about swapping it to something else.