Maximizing Orthotic Success With Basketball Players

Author(s): 
By Patrick A. DeHeer, DPM

However, making too much of a heel lift is contraindicated in the basketball device. As Dr. Kirby states, “Excessive heel contact point thickness (i.e., excessive heel lift) in basketball orthoses is contraindicated since this will raise the height of the subtalar joint axis from the floor and increase the mechanical leverage for ground reaction force to cause inversion ankle injuries in the athlete.”2 An arch fill with an accommodative material also provides more support to the midfoot while absorbing shock and reducing friction. The concern with this addition is the increased thickness to the device, which may make shoe fit all the more difficult.
A more recent addition that I have been routinely using is a reverse Morton’s extension made of Korex or Poron. This will not only aid in jumping by helping to engage the peroneal longus tendon but also provides further shock absorption to the forefoot. Metatarsal pads are useful in taking pressure off the metatarsal area and providing more midfoot support. Dr. 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.

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