Maximizing Orthotic Success With Basketball Players

By Patrick A. DeHeer, DPM

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. It is important to educate the team’s other medical staff on the correct technique of measuring equinus deformity (i.e. locking of the midtarsal joint to gauge ankle joint dorsiflexion accurately with the knee extended and flexed). Team medical personnel routinely stretch elite players. Therefore, in order to achieve adequate equinus reduction, utilizing a night splint becomes practically essential.
Compliance is very difficult for several reasons. Elite basketball players travel quite a bit and may forget to bring their night splint with them on a road trip. This is where the help of the trainer, who also travels with the team, becomes crucial. The trainer often carries things such as extra pairs of orthoses, shoes, etc., with him or her and it should be very little trouble to add a night splint. Trainers also have the ability to monitor the player’s use of the night splint while on the road.

In Conclusion
In summary, clinicians should first know the player’s biomechanics and pathology. Then find an orthotic lab that the DPM, the players and the trainer are comfortable with using. This season, I requested a sample basketball device from several orthotic labs and actually went over each sample with the trainer.
Semi-rigid devices with multiple layers of shock absorbing materials should be the goal in most cases. Use modifications as needed for each particular case. Send the shoes with the cast to the lab so the lab’s technicians can ground the devices to fit the shoe. Evaluate and adequately treat equinus deformity. Discuss an adequate break-in period with the player and the trainer. Maintain open lines of communication about the orthoses and the potential need for adjustments.
All of these suggestions can potentially increase the overall success of preventative treatment and rehabilitation of the elite basketball player.

Dr. DeHeer is a Fellow of the American College of Foot and Ankle Surgeons, and is a Diplomate of the American Board of Podiatric Surgery. He is also a team podiatrist for the Indiana Pacers and the Indiana Fever. Dr. DeHeer is in private practice with various offices in Indianapolis.


1. Major NM. Role of MRI in prevention of metatarsal stress fractures in collegiate basketball players. Am J Roentgenol. 2006 Jan; 186(1):255-8.
2. Personal communication with Kevin A. Kirby, DPM.

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