Reviewing pertinent aspects of choosing an appropriate basketball shoe for athletes of varying ages and play levels, this author discusses key shoe features, playing surfaces and injury ramifications.
“What is the most appropriate shoe for me?” This may possibly be the most common patient question for any of us who treat athletes of any age or proficiency. Of course, there is not always a straightforward answer, whether we are being asked about running shoes, court shoes, soccer boots or, for me especially, basketball shoes. I have worked in professional basketball for 25 years with the Washington Wizards of the National Basketball Association (NBA) and the Washington Mystics of the Women’s National Basketball Association (WNBA). I have had the opportunity to work with athletes from beginners to professionals. Many factors weigh into the choice of shoe, including price, past injury and, in basketball particularly, shoe size. People who participate in basketball often have difficulty finding large enough shoe sizes at a typical sports store.
When it comes to basketball shoes and recommendations for athletes, one should have an understanding of the history of basketball shoes (click here to read “A Pertinent Overview Of The Evolution Of Modern Basketball Shoes”). Why does this matter? The reality is many of today’s shoes are not just for playing basketball, they are fashion statements, which slightly complicates the selection process.
So how do we choose and make recommendations for patients? Comfort should be the primary factor above all other factors. There has been a fair amount of research on basketball shoes in labs and during games with some conflicting information as to whether a shoe reduces injury risk or increases performance. With this in mind, let us take a closer look at some of these studies for further insight.
What Does The Research Reveal About Basketball Shoes And Injury Risk?
Do high-top or low-top shoes make a difference in reducing injury? A number of researchers have attempted to answer this question.
The ankle sprain remains one of the most common injuries in all athletics, causing an estimated 10 to 28 percent of all sports-related injuries.1,2 Reports indicate that 20 to 50 percent of individuals with such ankle sprains have some sort of subsequent documented disability.1,2
In a 1973 study, Garrick and Requa found a high-top basketball shoe was beneficial in comparison to a low-top shoe when it came to lateral ankle sprains.3 They also came to the conclusion that taped ankles in addition to the high-top shoe reduced ankle sprains.3 Although that study was well done, basketball shoes were not the same style or composition as today’s shoes. Shoes worn in 1973 were mostly canvas and did not provide any inversion or eversion support.
In contrast, Rovere and team performed a study to assess lateral ankle sprains in athletes.4 This 1988 study compared low-top shoes to high-top shoes both with and without braces. In their retrospective study involving 297 college-aged athletes, Rovere and colleagues found that low-top shoes with lace-up ankle stabilizers more effectively reduced lateral ankle sprains than high-top shoes with lace-up ankle stabilizers.
In 1993, Barrett and colleagues studied 622 college intramural basketball players to determine whether high-tops, low-tops or high-tops with an inflatable air chamber were beneficial in reducing ankle sprains.5 Their challenge was to assess current shoe technology at that time and see if there was indeed any difference between shoe styles and injury risk. They began with the working premise that taping, ankle braces and high-top shoes would theoretically reduce the risk of injury.
In their study, one group had previous ankle injuries, specifically three or more with two in the same ankle in the last year.5 The second group had one to two ankle sprains in the past year and group three never sustained an ankle sprain. Ultimately, these researchers came to the conclusion that there was no statistically significant difference in injury risk between the three types of shoes. The authors also contend that one of the deficiencies of his study, sponsored by Reebok, Intl., was the lack of identification of foot type and not dividing the patient groups into structural groups.5
Ottaviani and coworkers did a study in 1995 trying to measure the maximal inversion and eversion moments that the ankle can resist in the frontal plane.6 Study participants wore the Nike Air Force low-tops and the Nike Air Force Max high-top. Researchers measured inversion and eversion forces at the ankle at 0°, 16° and 32° of plantarflexion. There was a statistical significance from 0° in comparison to 16° or 32° but not between 16° and 32°. The study concluded that participants could generate up to 29.4 percent greater resistance to ankle inversion with a firmly-laced high-top shoe in comparison to a low-top shoe. While this is statistically significant, the researchers conducted this study in a lab using force plates rather than mimicking basketball activities.6
What Other Studies Have Shown In Regard To Plantar Pressures, Playing Surfaces And Cushioning Materials
In 2018, Kong and coworkers studied in-shoe plantar pressures in amateur basketball players performing basketball-specific movement tasks, including running, maximal forward sprinting, 45° cutting and layups.7 They measured peak pressures and pressure-time integrals in 10 plantar regions of the foot (hallux, second toe, lateral toes, medial forefoot, central forefoot, lateral forefoot, medial midfoot, lateral midfoot, medial heel, and lateral heel).
In comparison to running, researchers identified significantly higher peak pressures during sprinting under the hallux, second toe, lateral toes and forefoot regions.7 During maximal 45° cutting, increased peak pressures were evident at the hallux, lateral toes, medial and central forefoot regions, lateral midfoot region and lateral heel. Performing a layup increased pressure under the hallux and medial forefoot. With regard to pressure-time intervals, the sprinting, 45° cutting and layups displayed significantly higher values in comparison to running alone. The midfoot (~141 percent to 418 percent) and heel (~144 percent to 526 percent) showed significant risk for and increases of overuse injuries and stress reactions.7 Currently, many shoe companies emphasize the cushioning capability of the heel in the shoe.7 Kong and colleagues believe that this is a good opportunity for insole or orthotic use to alleviate the high loading in the forefoot.7
Other factors to consider include the type of playing surface. Firminger and team studied whether playing surface had an effect on Achilles or patellar tendons.8 Researchers assessed 30 male athletes jumping on three different surfaces wearing three differently cushioned shoes. These surfaces differed in firmness and the shoes had foam soles of differing materials: ethylene vinyl acetate (EVA), typical midsoles in most athletic shoes and thermoplastic polyurethane (TPU). The EVA insoles had two different densities: 55C, which is typical in most shoes, and 70C, which is stiffer.8
One can find the thermoplastic polyurethane in the Adidas Boost technology and is the most shock-absorbing of the three sole materials in the study It is also the heaviest material in comparison to EVA.8 Firminger and colleagues found no significance between the different sole materials on the Achilles tendon or patellar tendon when jumping, but there were statistical differences with landing on the Achilles tendon. The thermoplastic polyurethane reduced stress on the Achilles when landing in comparison to the EVA insoles.
Interestingly, the firmest surface reduced Achilles strain with landing.9 This seemed counterintuitive but there seemed to be some strain to the Achilles on less firm surfaces as it had to react to a surface that had too much give. These findings were statistically significant only for the Achilles tendon and not for the patellar tendon. There was no statistical difference on the patellar tendon when analyzing the shoe or surface. This information is helpful when determining shoe options for a patient with previous Achilles tendon or patellar tendon injuries.8
Can A Basketball Shoe Enhance Athletic Performance?
Mohr and colleagues in 2019 studied whether a lighter basketball shoe would increase performance.9 There is a belief that a reduction in shoe mass enhances athletic performance, a belief which has driven the design and marketing of lightweight shoes over the last few decades. This may be true with running shoes as a decrease of 100 grams in weight reportedly decreases the metabolic cost by one percent.9 intuitively assumed that lighter shoes would have a beneficial effect on performance in other sports.
Assessing the performance of individuals with three different shoe weights, Mohr and coworkers looked at the impact on vertical jumps and lateral movements.9 The basketball shoe they analyzed was the Adidas Adizero Crazy Light 2. The shoe weights measured 352 g, 510 g or 637 g for a differential of approximately 300 g from the lightest shoe to the heaviest shoe. For a portion of the study, participants were unaware of the weight differentials. For a second portion of the study, the researchers informed them of the variation in shoe weight. In the blinded portion of the study, there was no differential in athletic performance but in the unblinded portion, performance increased by 2.5 percent in the lightest shoe.9 The participants truly jumped higher and moved better laterally if they knew the shoes were lighter.
With these findings in mind, how do we recommend the best shoe to our basketball-playing patients? Most retail stores will primarily sell signature models of basketball shoes. These tend to be slightly more expensive but are better designed in comparison to non-signature shoes. For kids, this is a difficult sell because they tend to grow out of them quite quickly. My recommendation would be to choose a comfortable shoe with enough room in the toe box. Nike and New Balance tend to make shoes with larger toe boxes. The Lebron James series and the Paul George series tend to have a wider forefoot. New Balance has only a Kawhi Leonard signature shoe. Adidas, Reebok and Under Armour models tend to be cut more narrow.
For the basketball players I treat, I find it is beneficial to add an additional insole, across all ages, but especially in older players. The sock liners that come with basketball shoes are thin and easily replaceable. The lone exception to this is some of the early Kobe Bryant models with Nike. These shoes have exceptionally thick cushioned insoles that one cannot easily replace with an over-the-counter or a custom device. I have relegated these shoes to players without previous history of injury who need additional cushioning. I also find that most players benefit from a replacement insole, whether it is over-the-counter or custom-made, with additional forefoot cushioning to the sulcus. Often, basketball orthotics tend to be flexible and offer more of a custom footbed than a true biomechanically-controlling orthotic. Players like the ability to pivot without too much control.
For players with larger feet, shoes may be difficult to find at the average athletic shoe store. Ordering online directly through the shoe companies frequently offers the best opportunity to buy larger-sized shoes. Unfortunately, this becomes a trial-and-error exercise and one I do not typically recommend. Sometimes it does become the only option.
Today’s basketball shoes offer excellent shock absorption and stability in comparison to older shoe models. Some due diligence may be necessary to find an appropriate shoe for your basketball-playing patients but there are a lot of options available.
Dr. Osterman is a Diplomate of the American Board of Foot and Ankle Surgery, and is a board member of the District of Columbia Podiatric Medical Association. He is the current team podiatrist for the Washington Wizards and the Washington Mystics, and is a Past President of the American Academy of Podiatric Sports Medicine. He is in private practice with Foot and Ankle Specialists of the Mid-Atlantic in Silver Spring, Md., and Washington D.C.
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