Maximizing Orthotic Success With Basketball Players

By Patrick A. DeHeer, DPM
Kirby has found first ray accommodations to be very helpful in the basketball orthoses. “Forefoot accommodation for plantarflexed first metatarsals is common since plantarflexed first rays are very common among athletes involved in basketball,” he states.2 Additional Tips For Orthotic Management Another very important aspect to the overall outcome of orthotic therapy is to address the individual player’s foot biomechanics and any clinical deformities. From a correction standpoint, I will usually post the forefoot to the cast measurement and the rearfoot to vertical posting. Regarding rearfoot posting, Dr. Kirby cautions, “Excessive varus correction or medial heel skive in basketball orthoses should be avoided to prevent inversion ankle injuries, unless the athlete also has a significant flatfoot deformity with significantly medially deviated subtalar joint axis.”2 Dr. Kirby also relays a point of concern regarding posting and an athlete with a history of chronic lateral ankle sprains. “Athletes with chronic inversion ankle sprains should be treated with orthoses that have a lateral heel skive and forefoot valgus forefoot extensions, and may need additional ‘bracing’ from high-top shoes or ankle taping before each game and practice,” he says.2 Impression techniques are also very important in the fabrication of a custom device. I have tried all types of impression methods and scanning over the years, and have come back to the traditional non-weightbearing, neutral position, suspension casting. One additional technique I have employed that seems to have increased overall outcomes is plantarflexion of the first ray during the impression taking while loading the lateral column. Special Considerations For Dealing With Elite Athletes One must take several considerations into account when treating elite athletes like basketball players. An often overlooked aspect of total care is making a device to be worn during non-playing times. It is important to stress to the player the need for a continuum of care. This is the time for a rigid functional device if indicated. Once an acceptable device is agreed upon and the player wears it, one should keep an adequate supply of devices on hand and monitor the wear of the orthoses being used. Players should replace them on an as-needed basis in order to maintain maximum shock absorption, friction reduction, hindfoot control and midfoot support. Communication is also very important. It can be very difficult to get much information out of elite athletes about their orthoses but their input is very important for adjustments and modifications. Getting them to spend a few minutes discussing their orthoses with the DPM and the trainer can make all the difference in their satisfaction and overall treatment. Secrets To Ensuring Improved Compliance With Orthotics Compliance is another important aspect of orthotic therapy in the elite athlete. This can be very difficult and frustrating for a physician. A common player’s error is a lack of a “break-in” period prior to using orthotics in practice and game situations. The typical scenario is for the player to put a new device in his or her shoe and practice or play in game situations immediately. This results in discomfort or pain from the device. The player then takes the devices out of the shoes and gives up on them altogether. Ensuring an adequate “break-in” period is especially important for players who have never worn a custom-made device as they need an adequate adjustment period. It is crucial to discuss this adjustment period in detail with the player and trainer upon dispensing the orthotic. I like to have the player wear the device for one hour the first day in a gym shoe during normal walking and daily activities. Then one can increase this an hour per day so the player is wearing the devices full time by the eighth day. After the player is wearing the orthoses full time, he or she may start wearing them during shoot-around. Once he or she is comfortable with this, the next step is to wear the orthoses in practice. Wearing the orthotics during the game should be the last step in the process. If the player has worn orthoses previously, then there should be no need for this break-in period unless there has been a significant prescription change. Achilles tendon stretching is crucial for orthotic compliance and overall player satisfaction.

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