Packed Out Liners and Extertional Compression Syndromes Explained

[skiing-in-jackson]

/pseudo gimp central topic

Extertional Compression Syndromes and Related Pathologies Explained

As a ski boot liner packs out, we skiers needing to get better control, will tighten the boot further.

A few times a week I'll get skiers and boarders who are having pain at the front of the ankle- it can be anywhere from the lower shin to passing through the tibiotalar joint to the talonavicular joint. The “upper instep”... so to speak.



I talked with a guy last night who had not missed a day of the season. I have numerous friends racking up 100+ days of skiing for the year- far in excess of the 80 or so I have.

What I am getting at is that liners, and to lesser extent shells, have a finite life span. There are only so many engineering cycles in a given material. At a point the liner gets played out and can't handle, or adequately distribute, the pressures required for good skiing. While skiers in racey stock liners routinely get 150+ days from a stock liner, the industry standard is far less- around 25-40 days of real skiing for a boot in the “performance” category.

So bro homeslice wants more control, but is too broke to shell out bread for liners at this late point in the season, so he aggressively tightens his boot even more. What he is risking here is called a “compartment syndrome”. In sports med, this is called an “exertional compartment syndrome”. Visible or non-visible swelling may appear. It will be painful.

With socks off, take your heel and put it on your toe. Either heel, doesn't matter. Try to lift the toe. Feel how the tendons raise where your foot meets your leg?



Those are your Extensor Tendons. They flex thousands of times a day in a ski boot and take a beating. When your liner is shot, there is not sufficient padding to distribute pressure. Bruising or repetitive microtrauma can occur. As the tongue of the boot wraps around this area and the padding fades away, there is little left to protect this area/distribute forces.

Too much shell pressure because the liner is trashed... This area is susceptible to point pressure.

Once irritated, this area will take at least a week to calm down, maybe more. You may or may not see bruising. It will be tender to the touch and hurts flexing these muscles- mostly the tibialis anterior.

In addition to packed out liners, I attribute the problem to boots with less forward lean. Boots like Garmont Shaman and the Lange RS 130 have less forward lean making it easier to be in the back seat. Of course skiing in the back seat can cause an extertional compartment syndrome, but I'm talking about good skiers here. A bad landing or being forced into the back seat by a bump can happen too.

Skis with reverse camber/forefoot rocker/early rise are being skied in a more neutral position. Skier stance has changed. I place more emphasis on rear/mid foot control in the boot. It's very easy to strain this complex area.

Packed out stock liners and crusty old intuition liners are chief catalysts. As Intuition liners get packed out they seem to loose most of their mojo in the anterior ankle/instep.

A heel lift can give some relief. Removing any material from ankle wraps in the Achilles area will bring the skier a little further back. On a side note, when firming up a boot, I almost never put a full ankle wrap on a liner. I will only place medial and/or lateral c-pads. If I need to take up that space, I'll use Bontex or other custom cut pads. Careful with the Bontex as it takes up volume, but elevates the the foot. Good skiers and boarders hate Eliminator Pads as they adversely affect stance and balance. Custom cut padding that's thinner works better.

Grinding away some of the plastic on the lower tongue will really help, but then you've permanently modified the boot and when the swelling goes away, you're screwed by the extra volume you created.

Proceed as necessary.

Actual mileage may vary.

[mntlion]

good read, Thanks.

I would think that this would be more prevalent in people with less ankle range of motion (or with heifers, rather then calf's) and less often with a large ROM, or chicken legs? Any thoughts on that>

[creaky fossil]

Is "extertional" correct? Not "exertional"?

anyway, for what it's worth: I'm surprised at people who ski more than 20-30 days in stock liners. I find most liners are blown out and useless by 30 days. and I'm a skinny git who doesn't have a big heavy clump of bones & flesh torquing inside a boot.

[XtrPickels]

Also to note, that there are other compartments that may be affected. Namely on the lateral aspect of your leg.

I'm actually running into this problem with some clapped out intuitions as I wait for my new group buy liners to arrive.

[skiing-in-jackson]

Is "extertional" correct? Not "exertional"?

.

Thank you. Spelling is not my fortè.

[skiing-in-jackson]

Bump a a friend called me about this very issue.

[Magnoe]

Thanks for putting it together. It's very interesting. I ski the more upright Garmont Adrenalines but have fortunately not had any problems.... mostly because I don't get enough days on snow in the year (that part is unfortunate).

[GeezerSteve]

Thanks. I've had compartment syndrome in both tibialis anterior. The sports medicine doc theorized that a ski boot with too much forward lean contributed to it, among other things (e.g., a 240 lb. guy running lots of ultramarathons). Surgery (bilateral fasciotomy) fixed the CS, thank goodness.

Boots like Garmont Shaman and the Lange RS 130 have less forward lean making it easier to be in the back seat. . . . I place more emphasis on rear/mid foot control in the boot.

I recently talked to expert bootfitter and damn fine skier Jim Mates about FL and ramp angle. He would disagree with the first statement. Jim recently opined that too much forward lean promotes back seat skiing for many people, and he is now advocating a "tall, relaxed stance" skiing style with less ramp angle and less forward lean. (He acknowledges that this is a change of his previously held belief and practice.) Of course, ideal forward lean and ramp angle vary with an individual's physiology, e.g., calf size (mine are huge), ankle flex, etc. I am certain that, for me, more forward lean will put me in a back seat squat. Also I ski better when I am loading the ski with the ball of my foot (like most guys with huge calves, I'm a BOF athlete), so it's difficult for me to understand the "emphasis on rear/mid foot control in the boot."

Don't get me wrong. I appreciate your post and most of it makes sense to me, except the points noted above. Perhaps there's a more informed discussion elsewhere on TGR about forward lean, skiing "tall and relaxed" and skiing with one's ball of foot. What works for me is the result of much trial and error, and it may not work for others. I am certainly no expert on these matters, so let the flamers flame.

[Judo Chop!]

hey big steve,

what symptoms did you have with your tibialis anterior compartment syndrome? how did it present and what did it feel like?
What was your down time for surgery & recovery like?

[BushwackerinPA]

Really good info.

The easiest solution to upright of boots is to simply plan the solid lugs and lift the heel back to where they were 10 years ago. Upright stance is not for everyone and in fact I would say the majority of people are being held back(quite literally) by it.