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I work for and teach for a University hospital located in the south, specializing in orthotics and prosthetics. I have built dozens of lifts for cowboy boots, mainly for people with severe limb length discrepancies.
He is 100 percent wearing a boot with around 3-4 inches of heel to ball internal lifts. The biggest giveaway in my opinion is that the boots are probably 2-3 sizes too big. The toe break in a normal shoe happens at the widest part of the shoe, you can tell his big toe is currently right where the first methead should be. This is why it looks like he's wearing genie shoes, the shoe is breaking closer to the toe box because there's nothing in them to prevent them bending backwards. .
Now if he wasn't wearing lifts he wouldn't be able to keep them on, as cowboy boots require a tight fitting vamp to stay attached. The lift raises the heels and thus the dorsum of the foot to press tightly against the vamp of an oversized boot.
The biggest thing I see that the article missed is that you can tell he is in hindfoot varus. Which is generally what happens when you do a sustained heel raise, enable to occasionally offload the posterior tibial tendon, moving some of the load to the peroneal tendon. This is why his foot is rolling over the lateral aspect of the boot.
This could occur naturally, but it's pretty rare outside of people who were born with clubbing in their feet. So I looked for other pictures of him walking in different shoes and found a pair of him walking in rain boots. In that picture he was over pronating and running over the medial side. So it's safe to assume that the supination in the boots are not a naturally acquired deformity.
If it makes anyone feel better, this guy is in some serious pain anytime he wears his lift. If he hasn't already done so, he looks like he's not to far away from a Jones fracture in his left foot. The left side looks like he's about 5-7 degrees of extra hindfoot varus than his right, which usually means he's damaged his peroneal tendon, or where it attaches to at the base of the fifth tarsal bone.
I love that I can find a expert who can jump on with their professional views on a random topic here haha. Cool!
Legend
Thank you for your in-depth analysis!