Basketball is a sport that's increasing
in popularity both in the US and abroad. New developmental (minor) leagues
are forming, and, certainly, at the high school level we see many more
athletes participating in the sport. This year alone, over 1.6 million
injuries will occur in people playing basketball. These injuries may be
either acute or chronic. Proper treatment of both types is important to
prevent long-term disability.
Acute injuries are those events
that occur traumatically at a specific point in time. Chronic or overuse
injuries occur over a much longer period of time and the athlete often
cannot point to a direct situation or cause of the problem.
The ankle is made up of 3 main
bones; the lower end of the tibia, or shinbone, and the fibula, or outer
bone of the ankle, and the talus that lies between the tibia and the fibula.
Holding these structures together are the ankle ligaments that connect
one bone to another. Holding the shinbone to the talus bone on the inside
of the ankle is a very strong tissue called the deltoid ligament. On the
outside of the ankle are 2 smaller ligaments holding the fibula to the
talus bone, and 1 ligament from the talus to the calcaneus (Fig. 1). Also
not to be forgotten are the muscles that surround the ankle that help propel
it and allow athletes to run and jump.
Achilles tendinitis is the most
common injury of the foot and ankle. At the point where the calf muscles
combine, they form the strong, rope-like Achilles tendon that inserts on
the back of the heel bone (Fig. 1). This tendon allows the calf muscles
to push the foot and toes downward, allowing a person to run or jump. In
running or jumping sports, such as basketball, this tendon can become irritated
and cause chronic problems. Repetitive overuse of this tendon can cause
the overlying sheath of the tendon to become inflamed. This results in
chronic pain and tightness of the tendon, which is Achilles tendinitis.
Achilles tendinitis usually develops
slowly, frequently resulting from a change in training, such as adding
mileage or hill running. The problem is usually an excessively tight muscle
in the Achilles tendon muscle group that causes inflexibility. This causes
the tendon to become stretched, which can lead to inflammation and swelling.
If the problem persists, it can lead to microtearing or complete tears
of the tendon. Symptoms include pain when the muscle is stretched, both
during and after an activity, and visible swelling. If symptoms persist,
a small scar tissue nodule can form within the tendon and cause severe
Treatment for Achilles tendinitis
includes rest until the acute inflammation subsides, ice to the affected
area, and anti-inflammatory medications such as ibuprofen. A small heel
lift can be used to reduce tension on the Achilles tendon. A stretching
and strengthening program of the muscles influencing the Achilles tendon
is vital for long-term benefits.
The ligaments of the ankle undergo
a tremendous amount of stress during basketball maneuvers. One of the most
common injuries in basketball is the ankle sprain, where the ligaments
are stretched or torn after the foot is rolled inward (Fig. 1). Ligaments
heal but remain loose after an injury; therefore, multiple sprains can
result in chronic ligament laxity. As the ligaments become more and more
stretched after an inversion injury, the ankle has a feeling of giving
away even with minimal motion. The ankle may be swollen, and the injured
person will often say that he or she cannot pivot or twist on the ankle.
Rehabilitation exercises are often
used to condition the muscles around the ankle to help maintain stability.
The ankle muscles themselves can help make up for the stretched ligaments.
A brace can also be placed around the ankle to help support the ligaments
if the looseness is not too severe. If these treatments are not effective,
surgery may be necessary.
plantar fascia is the hammock that connects the bottom of the heel bone
to the bottom of the toes. This hammock of fibrous tissue provides structural
support for the bottom of the foot. An excessive amount of stress on this
area can cause extreme pain at the weakest point of the hammock, where
the plantar fascia attaches to the heel bone. This also causes swelling
of the hammock, which is known as plantar fasciitis (Fig. 2). Indications
include pain with the first few steps after rising from a seated position.
Pain seems to quickly subside after movement begins. However, these symptoms
may worsen over time and occur for longer periods after rising. Plantar
fasciitis is probably the result of inflexibility somewhere else in the
foot or ankle. For example, if the Achilles tendon is too tight or inflexible,
this force is transmitted to the plantar fascia hammock and scar tissue
and inflammation will result. A physical examination reveals tenderness
on the bottom of the heel as the examiner pushes on this area. The patient
feels shooting pain that sometimes goes down into the toes. In general,
the Achilles tendon is tight, and other portions of the foot may prove
to be inflexible as well.
Treatment for plantar fasciitis
includes a period of rest, inflammatory medication, and an aggressive stretching
program to help remove the excessive force placed across the plantar fascia
hammock. Once treated, inflammation, swelling, and other symptoms will
Stress fractures, also called fatigue
fractures, can be disabling problems for athletes. Stress fractures in
the lower extremities are related to overuse. In the foot and ankle, they
most often occur in the distal shinbone, or tibia, or at the base of the
fifth metatarsal, or in the lateral (outside) foot bone. A stress fracture
is a phenomenon whereby multiple, repeated stresses can easily lead to
a fracture. It is important to recognize stress fractures early on. If
a stress fracture is missed, it could potentially lead to a complete fracture
with devastating consequences.
Symptoms of stress fractures include
pain directly over the bony area, such as the shinbone, with swelling and
inflammation. X-rays are often negative because the bones have not completely
broken. Often, a bone scan or a MRI is required to diagnose these injuries.
Once diagnosed, there should be a period of immobilization and no weight
should be placed on the injured body part.
Rehabilitation exercises will be
required to ensure optimal flexibility in the area. Once symptoms have
subsided and once flexibility is again attained, the athlete can generally
return to play without difficulty.
Basketball is a demanding sport,
but with a good strengthening and flexibility program, most basketball
players can continue to play at the level they desire.
Robert J. McAlindon, MD