Maximizing Orthotic Success With Basketball Players
When a foot and ankle specialist is involved as part of the medical staff for a college or professional basketball team, the demands on injury prevention and rehabilitation are significant. This high level of specialized care in the professional and collegiate setting involves several people, including the players, coaches, trainer, other medical staff and management in professional teams. Since treatment can involve the careers of those associated with the team, there is a certain amount of pressure on the treating physician. With so much at stake, two critical factors play an integral role in injury prevention and rehabilitation. Custom-molded orthoses and proper Achilles stretching therapy are of the utmost importance in overall treatment outcomes. The type of orthotic one emphasizes for the elite basketball player, implementation of orthotic use and proper equinus treatment require a well-orchestrated team approach based on education, communication and regular critical evaluation of the treatment plan. There has been little in the way of independent research on basketball specific orthoses to confirm the value of custom-made devices. Most of the literature to date has focused on running orthoses. What little that has been reported in literature regarding basketball devices has been anecdotal and based on personal experience. Recently, however, new independent research from Duke University Medical Center confirming the importance of orthoses in the elite basketball player has been receiving significant coverage in both the medical literature and media outlets. This recent study by Nancy Major, MD, utilized preseason MRI screenings of 26 elite college basketball players and stressed the use of custom orthoses in injury prevention and rehabilitation.1 The MRI screenings focused on bone marrow edema, specifically edema of the fifth metatarsal. Only one of the 26 players exhibited symptoms clinically at the time of the screening.1 However, out of the 52 feet the researchers examined, 19 (36.5 percent) showed bone marrow edema on MRI screenings. These abnormal findings led to treatment with orthoses and therapy, which led to successful prevention of any further stress-related injury with one noted exception of a player who developed a stress fracture before receiving his orthoses.1 Why Basketball Players Are Especially At Risk Several factors place the elite basketball player at risk regardless of the player’s foot structure and biomechanics. First, consider the movements that occur on a basketball court and the extreme amounts of resulting stress involved. The quick starting and stopping, lateral movements, linear running and sprinting, and jumping all lead to significantly elevated pressure levels on the forefoot and midfoot. The size of basketball players and the type of playing surfaces also play a role in the increased peak pressures occurring in the forefoot and midfoot. As with any type of elite athlete, the amount of time playing and practicing can additionally lead to stress-related injury. Kevin A. Kirby, DPM, has also found this to be true. “Basketball is a side-to-side sport and, as such, requires that the orthoses be constructed specifically to allow the foot to perform its necessary three dimensional motions relative to the floor,” states Dr. Kirby, an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College.2 Common lower-extremity injuries with basketball players essentially fall under two types: overuse chronic and stress-related injuries, and acute traumatic injuries. When treating elite basketball players, clinicians often see overuse types of injuries, including Achilles tendonitis, plantar fasciitis, posterior tibial and peroneal tenosynovitis, and metatarsalgia. The stress-related injury of primary concern is a stress fracture, which can be a prelude to a true fracture. This type of injury can lead to a substantial amount of missed playing time and may become career threatening. Another consideration one should examine is the relationship of chronic stress-related injures that may lead to an acute traumatic injury. Pertinent Pearls On Orthotic Selection Before discussing basketball orthoses, one must address the current state of basketball shoes for a realistic evaluation of basketball orthoses styles, materials and modifications.