Managing Common Basketball-Related Injuries

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How To Treat Navicular And Jones Fractures

Both of these injuries typically receive screw fixation, which provides both compression of the fracture site and internal stability for future stresses applied to the foot. If they are repeat injuries, they typically require bone grafting with new screw fixation. The use of a bone stimulator is always in use as well for NBA players since time needed for proper healing is very important in getting the player back on the court to play basketball again. The bone stimulator may not be available for the high school or college athlete due to insurance restraints.

This certainly brings the great caution of not letting the surgeon be talked into or pressured (usually by the athlete’s parents) into letting the athlete back into weightbearing workouts/competition before he has adequate bone maturation and healing to again withstand the stresses of the sport that the fracture site will experience.

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Author(s): 
Michael K. Lowe, DPM, FACFAS

   Linear running in stable running shoes provides both aerobic conditioning and the needed weightbearing to the joints. Most NBA players continue to play basketball in the offseason but are strongly encouraged to avoid playing in the neighborhood “pickup” games, in which someone may try to prove his manhood by taking the “NBA player” to the out of control limits of the game.6

   Of all the fractures that occur in the NBA, the metatarsal stress fracture is the most frequent. This is followed in frequency by tibial stress fractures and navicular stress fractures. These are truly overuse injuries. These are injuries which preventative medicine can have a great impact on both competitively and fiscally (money lost to the team by not having the player available).

   Both the navicular and Jones fracture injuries do not heal quickly and with professional basketball players (as well as with most athletes), we typically perform surgical repair to facilitate an appropriate, timely return of the athlete to competition. (See “How To Treat Navicular And Jones Fractures” at right).

   In my experience, players with any past history of plantar fasciitis or more than one stress fracture of the foot will benefit from the use of an accommodative orthotic device. Players frequently enter the NBA with a past history of previous metatarsal stress fractures from the college career. During my time in the NBA, the use of orthotics in the league has slowly increased from the low 40 percent range in the 1990s to currently upward of 80 percent of players on some teams, such as the Utah Jazz. Orthotics range from soft accommodative or shock absorbent materials to a semi-rigid polypropylene device with an accommodative top cover.

   There is also less taping of the foot and ankle now than we have used in the past for NBA players. In the 1980s, the player could be fined for not getting taped for game or practice. Now it is not uncommon for the player to use a commercially available ankle splint or even play without any preventive taping. Last year, several Utah Jazz players utilized the Adidas ankle splint (Adidas adiZero Speedwrap Ankle Brace) instead of the standard ankle taping.

Emphasizing Appropriate Shoe Gear And Timely Replacement Of Shoes

Proper shoe gear has a strong relationship to the performance and stability of foot function within the shoe. Those shoes that complement foot requirements for stability, flexibility and shock absorption can greatly aid in dissemination of stress to foot structure. This being said, much has changed with the use and function of shoe gear. Shoes have gotten much lighter (not unlike the changes to running shoes — think minimalist). The use of the high top basketball shoe is becoming much less frequent. Players are opting for lighter weight and lower cut “fashionable” shoe gear.

   At their highest point, according to the market research firm NPD Group, high tops accounted for about 20 percent of the United States market for basketball shoes. That number declined to 8 percent in 2010 while low tops grew from 11 percent in 2002 to 29 percent of the market in 2010.4

   Assessing the stride and gait of runners, Perl and colleagues recently found that minimally shod runners “are modestly but significantly more economical than traditionally shod runners regardless of strike type.”7

   The amount of stress applied to the shoe gear before replacement with a new shoe also has a profound influence upon protecting the athlete. The sports medicine practitioner readily recognizes the need of timely replacement of running shoes to prevent and treat existing injuries. In my experience, most runners are encouraged to replace shoe gear every 350 to 500 miles, depending upon the size and weight of the runner, and his or her running environment (i.e. road surface, trail running, moisture and mud).

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