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.

Michael K. Lowe, DPM, FACFAS

   The same should be true of the basketball player. I have found that the average runner will spend approximately 66 hours running to accumulate 500 miles on a pair of running shoes (8 minute/mile pace times 500 miles). In my experience, the average high school or college basketball athlete will easily work out 72 hours per month. Basketball shoes are now made of the same types of materials, namely ethyl vinyl acetate (EVA) or a polyurethane midsole and harder outer sole material. These materials all have a fatigue factor that greatly influences function of the foot and stress delivered to bone and adjacent soft tissue structures.

   Accordingly, I recommend that in high school and/or college, the athlete should replace his basketball shoes every month at least, due to the fatigue of the midsole material that subsequently ceases to protect the foot from the external forces of shock impact of running, cutting, and jumping. On the Utah Jazz, I recommend that players change shoes at least every two weeks and that the larger players (250-300 lbs.) change their shoes at least weekly, if not sooner.

   A positive secondary byproduct of frequent shoe change is that of protective influence of shoe gear on the foot and ankle stability in response to the external forces. As the player accumulates hours of wear on the shoe, the leather or synthetic uppers slowly begin to stretch and/or fatigue in response to the repetitive rotational forces as well as the considerable moisture buildup that occurs. Also, midsole material slowly deforms or compresses in response to the repetitive ballistic starting and stopping of the workout or game. As these external forces to the shoe continue, the rotational movement of the foot within the shoe slowly increases in range of motion and velocity, and thus slowly begins to decrease in its ability to diminish the external forces to the foot. Indeed, worn out shoe gear is certainly one of the great causes of metatarsal stress fractures and plantar fasciitis.

Addressing Common Ankle Sprains

The most common injury over my many years in the NBA is the lateral inversion injury to the ankle. Even with all of the proper use of shoe gear, taping or ankle supports, inversion injuries still are a frequent occurrence in basketball. In my 34 seasons with the Utah Jazz, I have seen many ankle sprains. However, I am still impressed that in those 34 seasons, not one surgical repair has been required or performed to get the injured player back to full speed again.

   The sooner that “RICE” can begin, the quicker the player is back to full recovery. This also consists of rest until the athlete is pain-free to proprioceptive strengthening exercises. Compression wrap of the injured ankle is also very important in keeping the post-injury edema reduced to allow for the benefits of the ice and elevation of the affected ankle. The quicker one addresses post-injury edema and applies a compressive wrap to the ankle, the sooner the player will begin to recover and may initiate his strengthening proprioceptive exercises. We always address these injuries immediately as opposed to waiting until the next morning. Accordingly, one does not see the presence of “woody” edema with the rapid treatment of injury.

   If the athlete is tender enough, one should place a cast boot on the athlete in the training room and have him or her use crutches. Crutch usage will typically end in 24 to 48 hours and the cast boot will come off when the athlete can bear full weight without pain, usually two to four days post-injury (thus enabling range of motion to begin to leg muscles and the ankle joint with continued daily physical therapy and compression wraps).
Proprioceptive deficits are frequent post-injury findings of ankle inversion injuries. The player must have a return of strength and proprioception, or his ability to perform highly ballistic movement with that ankle becomes unlikely. Secondly and just as important, without strength and proprioception, the rate of re-injury of the same ankle is significant.8,9

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