Triple whammy - high arches, wide forefoot & pronation

[ScullySkater]

I'm an adult skater (passed Bronze MIF and 4 of the Preliminary Dances) and I've gone through all the previous threads about possible fixes for over pronation. Unfortunately, I can't seem to find anything that addresses my combination of issues: very high arches, wide forefoot/narrower heel and over pronation in my right foot only. I am open to any and all suggestions, including recommendations for sports podiatrists or orthopedists specializing in feet/ankles in the Washington DC area who have experience working with figure skaters/ice dancers.

I currently skate in an all-leather C-width Jackson Elle boots in good condition. I'll probably end up going to a custom or at least split-width for my next set of boots since I've had to add some extra moleskin padding inside the boot to prevent heel slippage. I've been using CRM high arch insoles (I know, they're made for hockey skates) for the past 2 years, which work better than the yellow Superfeet did. I've not tried the R-Fit insole system by Riedell. I lace my skates the "standard" way, leave the top set of hooks unlaced and wear Bunga sleeves on both feet to prevent lace bite.

The over pronation in my right foot is not a new issue, but it is causing problems as I tackle more advanced skills and try to get deeper outside edges for dance. Neither of my coaches see any issues with my body alignment or lean. When I switched out my freestyle blades for synchro blades 2 years ago (to be able to do MIF and ice dance using 1 set of boots/blades), Mike Cunningham adjusted the blade alignment and placed a small shim between the blade mounting plate and boot sole. He watched me skate between each "tweak" until we did the most that could be achieved with outside the boot fixes. My regular sharpener is also very competent, so I don't think it is an issue with uneven blades, incorrect ROH, etc.

I managed to dig up one older post that said if you have already moved the blade medially, any adjustments inside the boot to correct over pronation should be to the lateral side. It sounds counter-intuitive, but I did experiment with placing home-made wedges (using thin layers of craft foam) in either the lateral or medial heel of my right boot under the CRM insoles last week. Neither modification made a difference.

My ankles are quite strong since I continue to do daily exercises and ballet barre several times per week. I did have some peroneal tendonitis in my right foot in December that resolved with PT. My PT and regular podiatrist have both told me that I have very tight Achilles' tendons bilaterally, so I stretch them multiple times per day. My podiatrist offered to refer me to someone who can make custom orthotics for my skates, but the consensus seems to be 50% of people love them and the other 50% say they are a waste of time and money. I have no issues with over pronation in street shoes, when doing other athletic activities or in ballet shoes.
 
So, have at it people! What else should I try to get my funky right foot to behave so I don't have to fight to keep it from rolling onto an inside edge?

[icepixie]

I have high arches, a wide forefoot, and narrow heels. Avanta is the only brand that's really worked for me. They're expensive, but it was worth it to not skate in pain and/or with numb feet from ill-fitting boots. But if Avanta is out of the question, I had some success with placing cut-up foam insoles under my arch and along the sides of the heels, as well as skipping a hole over the top of my foot and making a channel down the middle of the tongue with cut-up kitchen sponges. (Details and pictures in this thread.)

I tend to fall to an inside edge on my right foot more than my left, but it seems more to do with my right hip being higher than my left. If anything, my feet supinate. I've fixed it reasonably well by moving the blade inward, but it sounds like you have much more trouble than I did. That said, I find that when my hip/butt/core muscles are strong, I'm less prone to tipping to an inside edge. PT helped a lot here. Might help you?

[supersharp]

I'm an adult skater (passed Bronze MIF and 4 of the Preliminary Dances) and I've gone through all the previous threads about possible fixes for over pronation. Unfortunately, I can't seem to find anything that addresses my combination of issues: very high arches, wide forefoot/narrower heel and over pronation in my right foot only. I am open to any and all suggestions, including recommendations for sports podiatrists or orthopedists specializing in feet/ankles in the Washington DC area who have experience working with figure skaters/ice dancers.

I currently skate in an all-leather C-width Jackson Elle boots in good condition. I'll probably end up going to a custom or at least split-width for my next set of boots since I've had to add some extra moleskin padding inside the boot to prevent heel slippage. I've been using CRM high arch insoles (I know, they're made for hockey skates) for the past 2 years, which work better than the yellow Superfeet did. I've not tried the R-Fit insole system by Riedell. I lace my skates the "standard" way, leave the top set of hooks unlaced and wear Bunga sleeves on both feet to prevent lace bite.

The over pronation in my right foot is not a new issue, but it is causing problems as I tackle more advanced skills and try to get deeper outside edges for dance. Neither of my coaches see any issues with my body alignment or lean. When I switched out my freestyle blades for synchro blades 2 years ago (to be able to do MIF and ice dance using 1 set of boots/blades), Mike Cunningham adjusted the blade alignment and placed a small shim between the blade mounting plate and boot sole. He watched me skate between each "tweak" until we did the most that could be achieved with outside the boot fixes. My regular sharpener is also very competent, so I don't think it is an issue with uneven blades, incorrect ROH, etc.

I managed to dig up one older post that said if you have already moved the blade medially, any adjustments inside the boot to correct over pronation should be to the lateral side. It sounds counter-intuitive, but I did experiment with placing home-made wedges (using thin layers of craft foam) in either the lateral or medial heel of my right boot under the CRM insoles last week. Neither modification made a difference.

My ankles are quite strong since I continue to do daily exercises and ballet barre several times per week. I did have some peroneal tendonitis in my right foot in December that resolved with PT. My PT and regular podiatrist have both told me that I have very tight Achilles' tendons bilaterally, so I stretch them multiple times per day. My podiatrist offered to refer me to someone who can make custom orthotics for my skates, but the consensus seems to be 50% of people love them and the other 50% say they are a waste of time and money. I have no issues with over pronation in street shoes, when doing other athletic activities or in ballet shoes.
 
So, have at it people! What else should I try to get my funky right foot to behave so I don't have to fight to keep it from rolling onto an inside edge?

I have high, flexible arches, a medium width forefoot and a very narrow heel, and both feet pronate if when relaxed...the left more so than the right.  I did a lot of dance growing up, so my feet were super strong and I was able to hold my feet/legs in whatever alignment was necessary. I did not realize until much later how troublesome my feet were going to become.

Fast-forward to my late 30s when I started teaching skiing instead of just skiing for fun, and I discovered that it was simply not possible to get any kind of performance out of a stock insole. Superfeet were great in my shoes but just not enough to allow me to have any kind of finesse.  I got custom cork footbeds made and it was amazing.  Having that consistent platform under my foot that matched the shape of my foot made so much difference.

When I started skating (as a conditioning plan for skiing), I put superfeet in my skates and it was way better than nothing. I applied tape to shim the medial side and that helped, but I really struggled with inside Mohawks because if I relaxed my foot enough to get in the correct position to shift my weight, I would overpronate and have to quickly hop to the other foot. Terrible (and hideous) technique.  As a dancer, I know when my body line is awful and that Mohawk was like fingernails on a chalkboard.  Yes, I was on inside edges, and yes, I changed from FI to BI, but it was not the lovely sweeping move that was demonstrated for me, nor was it even the quick choppy move done by hockey skaters.

My first skates were Jackson Artiste with the nasty rec blade, up through Adult Basic Skills. They never fit right (the heel was way too wide) so I switched to the Riedell Silver Star with a Jubilee blade.  It was a great setup for my level but even with the special skating superfeet that they had just started making (2005-ish), my arches couldn’t stay stable if I relaxed my feet. So frustrating.  I made it up through Bronze MIF and PB dance in those boots, though, even though the heel was always a bit too wide.  Finally, my arches were having brutal muscle spasms at the end of each skate session and I had bone spurs from too much room in the heels, so I had some custom boots made by Harlick.  Foot impressions, tons of photos, and about a 4-page description of my feet and skate issues (they said “you can’t tell us too much”, but they may have rethought that after my submission, haha).  Warning:  don’t ask a ski instructor to describe their feet unless you have loads of time and probably a beverage to take the edge off.  And be careful about taking up figure skating as conditioning for skiing, because it can pretty much take over your life.  I went back into engineering and now I skate way more than I ski.

The Harlicks have pretty much been magical for me.  The custom insole solved my foot problems and I had to relearn a number of things once I had access to the fundamental movements that the other skates wouldn’t allow.  Skating is still a really difficult sport, but now I have what I need to be able to work on it.  I just got my 3rd pair of custom boots last month. Each pair has been re-stiffened a few times before I feel like I’ve kind of killed them, so over time I pay about the same for a pair of custom boots that lasts twice as long (with minor rebuilds at a ridiculously low price) as I would for two pair of stock boots that don’t quite fit.  Harlick works with people with foot issues all the time and they offer things like an additional cork wedge under your insole.  I’ve made a few changes over time, like switching from an all-lamb skin tongue to a half-lamb skin, half-foam tongue when I had a tendon issue.  I just call and explain what’s going on and each time they have offered really good guidance on what could help.

You can check out the Harlick website here:  https://www.harlick.com/

And there is a discussion about pronation problems here:  https://www.harlick.com/order/faq.php under “why do I fall on an inside edge...” that also leads to a link to a podiatry website that I found very interesting.

While you figure out what to do about skates, I’ll add that I’ve had the best success by adding a shim under the medial side of my boot.  I’m the skate tech for our club so I do this fairly often.  I take tape and create overlapping layers that build a ramp that will be thickest at the medial side and gradually blend as you move laterally. I usually start around the middle of the insole with the first layer, unless the problem is so extreme that I need to use thin card stock instead. ( I did end up using multiple layers of my heavy-duty printer paper (used for report covers) for one guy.  It worked really well.)

My favorite tape for this is a red stucco tape that is basically thin vinyl tape.  Very stable and doesn’t have the same breakdown issues that duct tape has.  It doesn’t last forever but it’s pretty good stuff.  Thinner than electricians tape, which is also good but the wider tape is more useful.

https://www.google.com/shopping/product/13749655950260154258?q=red+vinyl+tape+home+depot&rlz=1C9BKJA_enUS672US672&hl=en-US&biw=1024&bih=649&tbs=vw:l,ss:44&prmd=sinv&prds=eto:471577190419887136_0,cdl:1,prmr:1,cs:1

You don’t need the tape under your toes if there isn’t room.  If you want more detail, let me know, I am happy to help.

Good luck!

[Query]

Known sports podiatrists who work with skaters:

Dr Paul Meissner, in Cockeysville, MD, USA. He also plays hockey, and is the father of Olympic skater Kimmie Meissner. He may be the best known podiatrist for skaters in the DC area. I've known about a dozen people who were misfit for boots by the same person I was, and saw him to correct it.

Many local skaters and skate techs praise Jonathon P. Contompasis who practices in Wilmington, DE, Newark, DE, and Kennet Square, PA. He is a surgeon.
http://www.brandywinepodiatry.com/doctors-bio/jonathancontompasisdpm.html

Someone on skatingforums praised Dr. Michael Donato in Fredericksburg, VA, USA. (Another link.) He is also a hockey coach, and a surgeon.
https://www.rappahannockdpms.com/staff

I don't have this problem. But people I have talked to who solved somewhat similar problems have mentioned various solutions. I assume you have already tried tape under the insole under the arch, to support the foot enough that it doesn't collapse much. That's basic, and very common. I have indeed heard some people some people who support the lateral side, but I don't understand that. Intuitively, it seems like you want to prevent the medial side foot collapse, by leaving no room for such a collapse. In other words, try to make up for a deficiency of internal support by providing external support. (Possibly augmented by moving the blade closer to the medial side, which is what most fitters do instead, though I decided I personally dislike the effects of such offsets. Maybe you have also tried squeezing the foot around the area that pronates (by adding moleskin to the sides of the boot, or by making an insole that wraps around the foot there, so there is no room to collapse - that seems extreme to me, and I wonder if it can be healthy, but one skater who had troubles, including both a high arch and pronation, reported some success at one point from this approach. And maybe you have tried moleskin higher up on the side of the boot, near the ankle, you collapse towards, and perhaps moleskin on the outside of the lower foot below that to create a torque to try to prevent that collapse.

Perhaps the right attitude is that you don't have a bad foot. You have a badly fit boot that doesn't provide you the support you need. Hopefully, you just need to find the right expert(s), and/or experiment yourself.

Did you try full custom fit boots, fit by the factory store fitter, or by someone the manufacturer recommends? A skate tech I knew used to recommend Harlick a lot, and several people recommended them to me because I too have a wide forefoot, and also have narrow heels and short toes, and one leg is longer than the other, so both foot bottoms tilt to the left, but some people on this board have gotten good custom fit boots from Avanta (in California - but perhaps they are worth a trip), which has a podiatrist on staff, who does custom fittings. If that is too hard to get to, they can also work from foot casts created by other podiatrists. Of course full custom boots are even more expensive than seeing a podiatrist. Some people find they have to do both, and maybe experiment themselves as well.

A Harlick fitter (Phil), who used to be Harlicks master boot maker, told me of a ballerina who wanted skate boots without an elevated heel, and they made her boots to meet that request. I don't know why - perhaps she wanted boots that were profiled more like ballet slippers or point shoes. I'm not sure if that applies to you. How well do shoes without an elevated heel work for you? If you did that, it is quite possible you would need to have your blades re-profiled by an expert skate tech, to keep the balance point/sweet spot (transition in rocker radius) near the balls of your feet, and to make sure you can still use your toe picks right.

BTW, some people claim wide forefoots are natural - that most babies are born with them before the start wearing narrow toed shoes. I have no idea whether that is true, and there is obviously some variety. Given a proper custom boot fit that matches the shape of your feet, wide forefeet shouldn't be a problem. To some extent, a good fitter can stretch the toebox to the sides to match. And if your heel is also narrower than the boot, you can add moleskin there to get a snug fit, or make an insole that wraps around the sides of the heel.

[tstop4me]

I managed to dig up one older post that said if you have already moved the blade medially, any adjustments inside the boot to correct over pronation should be to the lateral side. It sounds counter-intuitive, but I did experiment with placing home-made wedges (using thin layers of craft foam) in either the lateral or medial heel of my right boot under the CRM insoles last week. Neither modification made a difference.

....
 
So, have at it people! What else should I try to get my funky right foot to behave so I don't have to fight to keep it from rolling onto an inside edge?

<<Emphasis added.>>  I don't believe this is correct.  I strongly over-pronate (previously normal arches, now collapsed, aggravated by additional foot and leg complications).  To correct for over-pronation, I use a three-step approach; how many steps you need depends on your degree of over-pronation.

(1) First move your blades towards the medial side.  I personally don't like to move them more than ~1/8" from the center longitudinal axis of the boot; though I know others who favor more extreme shifts.  I personally find extreme shifts make me feel unstable (a bit wobbly), and I don't care to have mounting plates extending past the side of the boot.

(2) If (1) is not sufficient, then, inside the boot, you want to lift your arch or heel (or both) along the medial side.  I ended up making my own orthotics, because I couldn't find a podiatrist in my area who was experienced in orthotics for figure skates (I wear prescription orthotics for walking shoes and running shoes).  Available space in your boot will typically limit the maximum amount of lift. 

(3) If (1) and (2) are not sufficient, then, outside the boot, you want to shim the blade along the lateral side.  Shimming needs to be done carefully; improperly done, you can warp the blade.  Skate techs typically use scraps of leather for shims.  I use thin plastic washers.  By stacking washers, I can readily vary the height of the shims.  They are also more stable than leather scraps.

I use all three steps to correct my strong over-pronantion..

Here's an excellent article written by a sports podiatrist: 

http://www.aapsm.org/sports-interest-articles.html

Scroll down to "Ice Skating"; and download the PDF for "Podiatric Management in Ice Skating" by R. Neil Humble, D.P.M.

[Query]

Interesting article.  I've seen it before, and mentioned it on my web site, but had forgotten about some of it.

I think some of it applies to hockey more than figure skating. E.g., the medially (inside) distributed weight balance, and more time spent on the inside edge. I was taught that most of the time figure skaters (though not while changing edges) we should also be balanced over the blade (where "over" includes a modification of the direction of gravity to include centrifugal forces), and should maintain the same edge depth throughout a lobe (I wonder if that is mostly an ice dance standard). "Power skating" also differs from what we do a lot of the time.

He wants to usually RAISE the heel. Definitely not for me. I had to have my heel cut down, because of pain, and I would choose a much lower heel if I got new skates. But since the o.p. does ballet, her feet must be more flexible. Let's think this through: if you balance more forwards, that might take some of the weight off the central part of the (medial longitudinal) arch, so it won't collapse as much, which I assume is what he means by pronation. Perhaps that is his goal?

BTW, AFAICT, pronation is used by different people to mean at least 3 different things.

1. It can mean that the person tends to balance their weight over the medial side, as many beginning skaters prefer, because they are afraid of falling outside, one of the reasons that some skaters have trouble reaching an outside edge. That can be corrected through practice.

2. It can mean the bottom of the foot is tilted sideways towards the inside, as is true of one of my feet. I think it is best not to try to correct the foot and body geometry, but to accommodate that shape by putting the wedge, or tape, etc., on the outside (lateral side). That way the whole foot bottom stays in good contact and control of the skate, by keeping equal pressure on all parts of the bottom of the foot. Before I did this, I had to continuously use muscle to keep all parts of my foot in good contact and control of the skate, and that over-use made my muscles sore. (My other foot tilts the other way. And strange as it may seem, I have no trouble in normal shoes or barefoot and little in roller and inline skates - only the effort of controlling balance over a skate blade creates problems.)

3. It can mean, as I assume you and the o.p. mean, that when you load the foot with weight, the medial longitudinal arch collapses more than the lateral longitudinal arch of the foot, due to asymmetric support within the body, so the foot bends sideways, inwards, at the ankle and/or below, and it is hard to hold the same skate edge depth. So you put the wedge, etc., on the inside (medial side) to partially prevent that collapse. To some extent, that means you do not have equal pressure on all parts of the bottom all the time, but pressure varies. I guess that means it is a little harder to maintain control of your edging, but hopefully not too hard. I believe you could also make an insole out of multiple materials with different foam compression characteristics, modulated in thickness, so you had more equal pressure on all parts of the bottom of the foot throughout all phases, though that isn't exactly what your are trying to achieve. But since I don't have this problem, I can't easily test it. Perhaps a good podiatrist can do this too, if it was desired.

And of course, people can have pronation (and supination) in different parts of the foot (e.g., front, middle and rear).

His orthotics are much fancier than most of the ones I have seen, that were just thin rigid supports heat molded off-the-shelf to fit the foot, to create equal pressure over the bottom of the foot. And much fancier than the insoles I have custom cut and carved to shape for myself out of camping mattress foam with a scissors.

Anyway, I guess what he talks about is what a real high end professional expert podiatrist can do.

And BTW, a lot of the people I know love what Dr. Meissner did for them. If the original poster can afford it, he might be worth it.

[supersharp]

Interesting article.  Sid Broadbent has a section in His Skateology book that shows how a hockey skater’s center of mass shifts as the blade rocker is moved (which is basically what adding to or subtracting from the heel will do).

Heavy-duty work boots often incorporate a heel, particularly for wild land firefighters and construction workers working on uneven ground. When the heel is elevated, it pushes the foot structure into a position that stabilizes the medial longitudinal arch and helps distribute the weight on both the ball and the heel. I find this type of boot much more comfortable than a boot with a flat sole (maybe because in Alaska, we don’t have very many flat surfaces, haha).

I’ve seen (and experienced) some pretty amazing changes in balance in ski boots by adding heel lifts and also by adding a toe lift (or removing a heel lift that wasn’t helping).

If you have a little space in your skates, you can play with the difference by adding a layer of moleskin under the heel of your insole or under the ball of the foot. It’s astonishing how much difference it can make. One layer of moleskin seems like nothing, but our bodies notice (our bodies are amazing)!  Just for kicks, put some on one heel and the other ball and then go skate. It feels crazy but it is really interesting.

I think the solution for each foot problem is really specific to why the foot is off-balance or deforming (or whatever the problem is).  Going to a podiatrist and getting some PT were a really worthwhile investment for me.  Those of you who are near specialists that are skate-savvy are fortunate.

My foot instability comes from the shape of my calcaneus. If I let it lie flat on the transverse axis, my foot tips medially and my Achilles’ tendon is not vertical, and my arches and knees hurt unless I use my muscles to hold the foot in correct alignment.  If I shim (or “post” as podiatrists tend to say) under the medial side of the heel, I can relax the foot and it is stacked in good alignment.  My PT has me do a lot of exercises to keep the feet strong, and says that in my case, the post under the medial side of the heel is fixing a structural problem.   Bigger problem on the left than the right. My custom insoles are molded to the bottom of my foot so I have full contact with the insole and my foot is posted as needed.

Query—Feet that have a tilt that isn’t bilaterally symmetrical, very interesting!  That puts you in a good position to help people of both foot types.  I don’t live having problematic feet, but I do like being able to help new skaters understand that their feet might be adding to their struggle.  Silver lining, I guess...

[Query]

Query—Feet that have a tilt that isn’t bilaterally symmetrical, very interesting!

It comes from having unequal length legs (maybe by 1/2" or a little more) - which isn't unusual. It might also be because I had a leg in a cast for 6 months.

Skating emphasis many things that don't much affect ordinary activities where you aren't balanced on a thin blade. A lot of people who start skating have problems they never noticed before.

I had a lot more problems from feet with wide toes and narrow heel - many ankle injuries, because most shoes don't fit that shape.

I wonder how many people would benefit from seeing a foot expert. I suspect far more than most people realize. E.g., why are so many shoes narrow at the front - aren't most people's toes at least as wide as the rest of the foot? Maybe ordinary doctors should be trained to look for basic issues. (I'm not saying they should have all the training of a podiatrist.)

[supersharp]

I agree, we should all have a detailed foot examination in our early 20s and then every decade it two afterwards.  It also would be great if we had an alignment check (sounding a bit automotive, haha) at those same intervals to identify unhelpful or out-of-balance movement patterns. 

Until I started trying to fix my skating issues, I had no idea how many body idiosyncrasies I had.  Just one more reason skating is a great sport as we age.

[tstop4me]

E.g., why are so many shoes narrow at the front - aren't most people's toes at least as wide as the rest of the foot?

I've posted on this before.  It's a classic instance of form over function, aesthetics over engineering.  In the early 1980s I went to a well-regarded tech in my area.  I remarked that I wished manufacturers would offer figure skate boots with wider toes, instead of the traditional pointed toes.  He mentioned that a European manufacturer had introduced boots with more functional square toes, but skaters thought they were ugly.  Sales were dismal, and the line was yanked off the market within a year or so.

About 6 yrs ago, my coach recommended that I look at Jacksons (I had been wearing Riedells). To my surprise, the Jacksons had more rounded toes.  The tech (an ex-competitive skater and also a coach) told me they were good boots, but many skaters resisted them because they thought they looked "klunky".  Enough skaters, however, apparently did put function over form:  Jackson seems to be doing well.  And before everything shutdown a year ago, I saw Risports at a pro shop, and several skaters at my home rink wearing them.  At quick glance, their toes appear to be even more rounded than those on Jacksons.  So maybe there's hope yet.  [On the other hand, I know several young girls who just had to have Edea Ice Flies because they're so cool looking, irrespective of whether they were the right boot for them.]

Many moons ago, I used to wear work boots with square toes.  You would think that this is a boot category in which function would definitely take #1 priority.  But I haven't seen them in years.

[Query]

Many moons ago, I used to wear work boots with square toes.  You would think that this is a boot category in which function would definitely take #1 priority.  But I haven't seen them in years.

Square toe work boots and shoes certainly exist
  https://www.amazon.com/Mens-Square-Toe-Work-Boots/s?k=Men%27s+Square+Toe+Work+Boots
though some look more like country-western fashion boots.

But was talking about what I would call flared-toed shoes and boots, for those of us with extra wide forefeet. (I don't know if that would apply to the o.p.) There are lots of sandals and flip flops like that, and shoes that look like feet are a current stylish fad,
  https://www.pinterest.com/pin/140526450842274179/
and there are even some snowshoes and short skis that look like that, but few if any real shoes or boots with flared toes - at least not regular stores or online - though maybe I just don't know what to call them in online searches.

P.S. "Flare" has a different meaning in orthotic shoes - it applies to widening the outsole, and is used for foot stabilization - including pronation - but would not work in skates, because the flare wouldn't touch the ice. If I remember right, I contacted the article author a few years ago, and pointed out something along those lines. Turns out he mentioned it in the article he submitted, but the editor removed it.

[ScullySkater]

Thank you to everyone who responded to my question! It's comforting to know I'm not the only person with this combination of challenges. To update everyone and answer some of the questions posed by respondents:

1) I have an appointment to see Dr. Paul Meissner on 3/11/21. It will be a 35 mile drive from my home, but given all the praise he's received here and on other forums, it sounds like it will be well worth it. Bonus: he is in-network for my insurance plan!

2) My PT wrote up a detailed account of my diagnoses and treatment plan and sent it ahead to Dr. Meissner. In his opinion, my foot issues are not related to any deficits in strength or flexibility. Neither he or my coaches see any misalignment issues further upstream from my foot/ankle either.

3) Things I've already tried that other posters suggested are: blade is set further in medially; blade is shimmed laterally; extra moleskin padding inside the medial ankle area of the boot; and various layers of craft foam under the back of the CRM high-arch insole.

4) Things I'm going to try before my appointment on Thursday: building up support with tape under the medial side of insole; putting wedges of various sizes (made with craft foam or moleskin) under the insole in the medial arch area of my right boot.

5) Someone mentioned heel height as a possible factor and asked if I feel comfortable in flat shoes. I actually prefer a bit of a heel (usually a wedge or thick heel) and a rounded toe-cap on closed-toed shoes. The only flats that are comfortable for me are Birkenstocks or Vionics. Even in my youth, I rarely wore high-heels, and never with pointed toes or stiletto heels. One of the things my dance teachers always emphasized to us was our choice of footwear in daily life could have a huge impact on our entire body.

6) When I get new boots, I don't really care about the aesthetics. It would be nice to have something lighter than my current all-leather Jacksons. but I hear mixed reviews about the new microfiber uppers being used by some manufacturers. If I'm able to get away with a stock or semi-custom boot, I've probably stick with Jackson or try Risport. If I end up having to go full custom, I'll look into Harlick
 and Avanta as well.

[Query]

Great!

Maybe ask him what to bring to the appointment.

E.g., he might want you to bring your old boots, any shoes with you have with orthotics, and the socks that you skate with. Maybe also bring skate guards (plastic and/or soakers), so you can stand in your boots on his floor, without carving it up. I don't know whether he has plastic "synthetic ice" tiles in his office, like one of the skate techs I knew did.

Amazing that he is in-network. I assumed, with all the glowing statements I've heard about him over the years, together with his familial association with an Olympic medalist, that he could charge more than any insurance company would pay. I'm also surprised that an insurance company can be convinced to pay for something sports-performance related.

Hope it goes well! Please tell us whether he manages to solve all your problems.

P.S. if your boots are designed to be heat molded - and as far as I can tell, they are - that is something that most reasonably competent skate technicians can do. A lot of people feel it helps, including me.

Likewise, I didn't see you mention that you have had a skate tech stretch ("punch") your toebox, or any other spots like ankle bones that might be squished. That is likely to be worth it. Do it AFTER the heat mold, because a heat mold undoes some of the stretch. I don't know what stretching and heating equipment he has in his office - ordinary light duty stuff designed for normal doesn't really hack it - and it takes hours or more to do a good stretch. While it would make probably sense to ask him before the appointment first, for both the heat mold and stretch, these are probably a safe bets, and are pretty routine in the skating world. Even many rough and tough hockey players who were sometimes taught to live with the pain now often have them done.

[Query]

P.P.S. If you have other athletic shoes, it wouldn't hurt to bring them too, just in case the question comes up. E.g., whatever you wear for ballet barre. A PT told me that skaters and dancers often see the same medical professionals. Of course, your insurance might not pay for work on more than one pair of shoes...

[Query]

1) I have an appointment to see Dr. Paul Meissner on 3/11/21.

What happened?

What did he do?

Is it permanent, or will you periodically need a new orthotic?

Could you duplicate what he did yourself on your next boots?

Did he fix everything?

Are you happy and comfortable?

[ScullySkater]

So, here's the lowdown on my progress toward finding boots and fixes that will work for me.  When I saw Dr. Meissner, he agreed with my self-diagnoses of high arches/pronation/wide forefoot and also said I have a "vagus" foot and very tight Achilles tendons. I always thought my tight Achilles were exacerbating the problems with my feet, but he says it's actually the other way around.  I already do regular stretching of my Achilles 3x day (and pretty much every time I do a plie during ballet), but he recommended a gadget called the "Pro-stretch" that his daughter uses. I got one for about $15 on Amazon and it does give me a deeper stretch than just using the floor or hanging from my toes on a step. Dr. Meissner also said the choice of the CRM high arch insoles were correct and he added in something called a "hap pad" that goes under the medial arch of the insole. For the first time, I feel something under my arches, instead of just air. However, for about 2 weeks my body was very unhappy as I had to make lots of micro-level adjustments to get back in alignment. I have found that a medium hap pad in my right boot and a small one in my left boot work best. My right outside edges are still not as good as the left outsides (FW or BW), but they have improved with this first set of fixes. Dr. Meissner also recommended that I get fit for new off-ice training shoes, which I did at Roadrunner Sports in Rockville, MD. They had me walk and on a treadmill in the store, then stand on a pressure plate where they took measurements and scanned my feet in 3D. Later, this info was input into another machine where I stood on insoles and they were custom molded to my feet!

On April 1 (no fooling), I went to see Peter Bilous at Skate Club of Wilmington. I used to see Mike Cunningham, but he returned last year and doesn't do fittings anymore. As soon as Peter looked at my feet he said "I know why Dr. Meissner sent you here". He remembered dealing with Kimmie's feet and said mine are similar. He also introduced me to his assistant (Dot), who has arches even higher than mine! When she was still skating, she had Dr. Meissner put custom orthotics in her dance boots and said they made a world of difference for her outside edges. After Peter watched me skate and looked at my current boots/blades, we talked about options. After going through the pros and cons of stock vs custom boots and various makers, I decided to go with the Jackson Debut (low cut). This should be stiff enough for spinning and freestyle moves, yet flexible enough for dance. I'd prefer a leather upper to the microfiber, but that would turn it into a custom job. Peter mailed my measurements to Jackson to find out if they can use one of their regular lasts for my feet, and the good news is that their wide width (C/D) last will work. I'm trying the carbon sole, since it's supposed to be a bit lighter. My current Jackson Finesse blades are only a year old, so I'll get them mounted on the new boots. Hopefully my boots will arrive within a few weeks and I can go back to Wilmington for heat molding, blade mounting, etc. If I'm still not satisfied with my right outside edges once I put the high arch insoles & hap pads in the new boots, then I'll go back to Dr. Meissner and ask him about custom insoles.

Dr. Meissner, Peter Bilous and Dot Gualtieri were all knowledgeable, sympathetic and did not try to upsell or BS me. It was well worth the 1.5 hour round trip drive to Dr. Meissner's office and the 4 hour round trip to/from Wilmington.

PS - another possible option is to have the running store mold insoles for my skates if they are thin enough.

[tstop4me]

PS - another possible option is to have the running store mold insoles for my skates if they are thin enough.

I don't think that's a good idea.  Insoles need to be customized for the particular application.  I have one set of prescription orthotics for my everyday (walking) shoes; and a different set of prescription orthotics for my running shoes.  As well as a different set of DIY orthotics for my skates.  The corrections needed for walking, running, and skating are different.

[Query]

He remembered dealing with Kimmie's feet and said mine are similar.

So we should now expect you to skate at least as well as Kimmie!

Wow. You needed 3 experts so far, not counting Mike, who I presume didn't do enough for you - a surprise to me, because he often referred people to Dr. Meissner or to Dr.  Jonathon P. Contompasis (a podiatrist who practices in Delaware, including Wilmington, and in Kennet Square, PA) for arch support issues.

I'm amazed that you could hold any edge if you didn't have contact under your medial arch. I would have thought the boot, and the blade with it, would continuously wobble left and right without such support. I guess you had some medial support from your heel and/or toes, or that you had a very snug ankle fit.

I'm glad that you were able to see people who seem to have done you some good!

I see that there is a Peter Bilous listed as the General Manager of the Skating Club of Wilmington, and one who is or was an ice dance coach (based on this). Is he also a skate tech, or something else? If he is a skate tech, does he have a reputation similar to what Mike Cunningham had before he retired? I.E., as an extremely competent skate tech, thought by some to be the best in a multi-state area? What about Dot?

Are you completely satisfied with what Dr. Meissner did so far?

Do you use orthotic(s) in ballet shoes? Do your arches and Achilles tendon affect ballet?

I know it is common for ballerinas to also study Modern Dance, which often involves flat footed moves, and other moves that stretch the Achilles tendon. Do you also study Modern, and do your feet and Achilles make that hard, or make you prone to injury?