Fig. 28.1
(a and b) Basketball shoes must allow for running, jumping, and lateral movement, while providing lateral stability to the subtalar and ankle joints. (Courtesy of New Balance, Boston, MA)
The combination of outersole and midsole determines the properties of the shank. It is essential that a basketball shoe has solid shank stability. The shoe should never have sagittal plane flexibility in the shank region. Some manufactures have reinforced the shank with fiberglass, plastic, or graphite material in an attempt to reduce bulk but maintain stability. Failure to maintain shank stability may contribute to a variety of problems including plantar fasciitis.
Perhaps the most well-known feature of the basketball shoe is the high-top construction which has characterized the sport (Fig. 28.2a, b). Prior to 1980, the vast majority of basketball shoes were constructed above the malleoli in an effort to provide lateral stability and reduce the incidence of lateral ankle inversion injuries. However, more recently basketball shoes have been increasingly constructed at or below the malleoli (three-quarter or low-cut). The reason for this is probably fashion driven, but the lower cut construction does allow for increased mobility of the ankle and subtalar joints which is certainly beneficial. There is evidence that high-top construction may actually increase shock transmission and reduce both running and jumping performance [3]. Most importantly, research has shown that even the highest top basketball shoe does very little in preventing lateral ankle injuries [4, 5].
Fig. 28.2
(a) High-top Reebok basketball shoe. (b) High-top Adidas basketball shoe
Volleyball shoes similarly are designed with the needs of the sport in mind. Gum rubber is the most commonly used outersole material. As with basketball shoes, the midsole is composed of ethyl vinyl acetate or polyurethane foam with occasional augmentation by gels and “air” cells. Volleyball shoes are all low-cut below the malleoli to allow for the frequent lunging and diving which occurs (Fig. 28.3). As with many basketball shoes, the desire to keep the shoe low to the ground for improved lateral stability is seen. As with basketball shoes, a stable shank is essential.
Fig. 28.3
Volleyball shoes are low-cut below the malleoli (Courtesy of New Balance, Boston, MA)
Custom Foot Orthoses
Custom foot orthoses usage in basketball and volleyball is common among recreational, collegiate, and professional athletes. Experience estimates that over 50% of basketball players and 30% of volleyball players utilize some type of pre-fabricated or custom foot orthotic device. These orthotic devices are prescribed by podiatric physicians, orthopedic surgeons, athletic trainers, physical therapists, prosthetists, and chiropractors. The variety of devices range from a leather insole with a heel lift and scaphoid pad to a custom functional orthotic device composed of thermoplastic and foam materials. The majority of orthotic devices utilized today are composed of light, resilient thermoplastic materials [6, 7].
In my experience, the most common orthosis requirements in basketball and volleyball are cushioning and stability. There is no true heel to toe progression for any significant amount of time during either of these sports and therefore the concept of the orthosis “functioning” is not possible. The orthosis usually fabricated is a hybrid with features of both a functional and an accommodative device, utilizing a semi-weightbearing casting method, often with foam. Maintain subtalar joint neutral position during casting and capture any forefoot deformity. Non-weightbearing neutral suspension casting technique may be utilized if desired; however, the laboratory should be instructed to use generous amounts of arch fill and lateral heel expansion because these athletes generally do not tolerate orthosis which are biomechanically correct. It is essential to balance any forefoot deformity as this prevents rearfoot compensation and increases subtalar and ankle stability. Malalignment such as forefoot valgus and rearfoot varus may predispose to lateral ankle injury [8]. It is best to apply any forefoot balancing extrinsically as only forefoot contact may occur during activity. In addition, orthoses have been shown to improve postural control which may also improve lateral ankle stability [9]. The typical device is composed of a polypropylene or polyurethane shell with some degree of arch fill composed of soft or medium-density ethyl vinyl acetate. Include a heel cup of at least 16 mm and any other modifications depending on the pathology being treated, and it is common to use a top cover of perforated ethyl vinyl acetate or microcellular rubber (Spenco). If additional cushioning is desired, add 1/16 in. Poron below the top cover. If shoe fitting is a problem, then arch fill can be reduced or eliminated. Forefoot thickness should be at least 1/8 in.
Sport-Specific Pathology
Lateral Ankle Sprain
As with most sports, the lateral ankle sprain is the most commonly encountered injury in basketball and volleyball. In fact, the lateral ankle sprain occurs more commonly in basketball than in any other sport [10]. The best preventive measure and management involves physical therapy and rehabilitative exercise, especially proprioceptive training [11, 12]. Ankle braces have been shown to improve ankle stability and reduce the incidence of inversion ankle sprains without adversely affecting athletic performance [4, 12]. Experience shows that basketball players favor lace-up braces and volleyball players generally prefer a more rigid device. As mentioned previously, custom orthotic devices have also shown some efficacy in the prevention and management of lateral ankle instability. The typical orthosis modifications include forefoot balancing, a lateral heel cup of 18 mm, and a lateral flare to the rearfoot post. In some cases a valgus forefoot post can be used to further stabilize the midfoot.
In cases of severe or chronic ankle sprains such as syndesmotic injuries, a Richie brace ankle foot orthosis is an excellent option for balancing the foot and obtaining maximal subtalar joint and ankle stability. Although this device is frequently used for tibialis posterior tendon dysfunction, it has excellent indications in cases of chronic ankle pain or instability.
Plantar Fasciitis
The second most common pathology encountered in both volleyball and basketball is plantar fasciitis. Both distal and proximal (“heel spur syndrome”). This ubiquitous overuse injury can be instigated by an unstable (flexible) shank and ankle equinus, which is considered to be the primary etiology [13]. With this being said, the most efficacious form of management is Achilles stretching, either manually or with a plantar fascial splint [14, 15]. Physical therapy, non-steroidal anti-inflammatory medications, injectable corticosteroids, orthotic devices, and extracorporeal shock wave therapy have all proven to be effective to some degree [16–18]. Regarding orthotic devices, there is evidence to suggest that pre-fabricated insoles compare favorably to custom orthotic devices [19]. However, in resistant cases, the use of a custom device, derived from a non-weightbearing neutral position cast with emphasis on plantarflexion of the first ray during casting is recommended. Balance the forefoot in slight valgus with a reverse Morton’s extension to further promote first ray plantarflexion. This will reduce the tension on the plantar fascia [20]. Varus posting should be avoided as this will increase tension on the fascia [21].
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