With the NBA playoffs in full force, college star Caitlyn Clark beginning her WNBA career: and the Paris Olympics on the horizon basketball is taking center stage in the sports world. Unfortunately, foot and ankle injuries such as ankle sprains, calf tears, plantar fasciitis, Achilles tendonitis, and stress fractures are an all too common occurrence among basketball players. These injuries can, and often do, impact the results of games and fundamentally affect the outcome of a series or tournament. As a recent example, Milwaukee Bucks star Giannis Antetokounmpo’s calf muscle injury knocked him out of the NBA playoffs and doomed his team to an early exit.
The dynamic nature of basketball; the size of the players; and the intensity of many games means that foot and ankle injuries are likely to always be a risk. Injuries can be acute from a single event, or chronic due to the large repetitive loads placed through the lower extremity. So, what are the most common basketball injuries affecting the foot and ankle (and the lower leg)? Some injuries are minor and a recovery can be expected in short order. Whereas other injuries are debilitating and may cause the loss of the season or even a career. Here is a review of some of the more common foot and ankle injuries that basketball players suffer:
Ankle Sprains
An acute ankle sprain is perhaps one of the most common basketball injuries. There are two types of ankle sprains. An inversion ankle sprain where the ankle rolls inwards tearing the ligaments on the outside of the ankle, and a high ankle sprain where the planted foot rotates outwards tearing some or all the ligaments connecting the two bones of the lower leg (the tibia and fibula) together. Of these two ankle injuries the inversion ankle sprain is by far the most common. In basketball this injury commonly occurs when a player changes direction suddenly or the player lands on someone’s foot after jumping. In both cases, the ankle rolls inward and ligaments on the outside of the ankle are stretched or torn. The severity of the ligament tearing dictates the extent of the injury. For many players, particularly those with loose ankles, some of the restraining ankle ligament fibers are torn, but they’re able to continue playing. Whereas for in more severe ankle sprains an extensive recovery might be required. Patient who have suffered previous ankle sprains, or have a higher arch foot are more likely to suffer sprain. Almost all ankle sprains can be treated conservatively without surgery. However, for patient that have repetitive ankle sprains due to looseness of the lateral ankle ligaments their ankle instability may need to be addressed surgically.
Calf Muscle Strain
A Calf tear or calf strain is another relatively common basketball injury. This injury often occurs following at dynamic movement such as suddenly changing direction. These activities cause the calf muscles to contract and lengthen at the same time creating considerable force within the muscle which can leads to tearing off some of the muscle fibers. This muscle injury can be debilitating. It is often a number of weeks before players who have suffered a calf muscle tear can return to competition. The muscle injury needs to heal with scar that is strong enough to withstand the large forces that occur during the running, jumping, and change of direction activities that commonly occur in a basketball game.
Plantar Fasciitis
Chronic heel pain due to plantar fasciitis is another common problem among basketball players. The plantar fascia is a strong fibrous tissue that runs through the length of the sole of the foot. In basketball players repetitive loading of the feet due to running and sudden changes of directions can create microscopic tearing at the origin of the plantar fascia where it attaches to the heel bone. The body responds to these microscopic injuries by sending inflammatory mediators to this area leading to notable pain in the heel area. Basketball is a dynamic game, and players are often tall and heavy. This combination creates tremendous loads through the fascia increasing the likelihood that basketball players will develop plantar fasciitis over time. Also, a tight calf muscle can help a basketball player jump high, but it also increases the force through the plantar fascia predisposing to the development of painful plantar fasciitis. Fortunately, with a consistent calf and plantar fascia specific stretching program as well as other treatment strategies most cases of plantar fasciitis can be resolved or controlled.
Achilles Tendonitis
Similar to the plantar fascia, the Achilles tendon can be subject to extraordinary repetitive loading forces in the course of a basketball game. Microscopic injury to the Achilles tendon can lead to tendonitis. This can create pain and swelling around the tendon and which can make playing basketball difficult or impossible. Dynamic activities, such as jumping and sudden changes of directions combined with the size of many basketball players, all serve to increase the forces going through the Achilles and the potential for Achilles tendonitis. A coordinated Achilles tendon stretching program, local soft tissue massage and mobilization, and backing off activities in the short term will usually lead to an improvement or resolution and symptoms — although Achilles tendonitis can become a chronic issue.
Achilles Tendon Rupture
A ruptured Achilles tendon is a devastating injury for a basketball player! Dynamic forces can create loads through the Achilles that are 4-7 times bodyweight. These forces combined with wear and tear of the tendon with age can lead to a catastrophic rupture of the entire tendon. A ruptured Achilles tendon is an all too common basketball injury with many elite NBA stars having suffered the injury including: Patrick Ewing, Kobe Bryant, and Kevin Durant. Recovery following an Achilles rupture is prolonged and it is often a year or more before players are fully recovered. The Achilles tendon itself not only needs to heal, but it must heel strong enough to be able to withstand many times bodyweight. Also, the Achilles and lower leg must be relatively immobilized after the injury in order to facilitate healing of the tendon. During this period of relative disuse the calf and other lower leg muscles become noticeably atrophied and these muscles have to be gradually strengthened over time. For these reasons an Achilles tendon rupture is often a career-ending injury for many professional basketball players.
Shin Splints
Chronic pain in the shins due to shin splints is regularly seen in basketball players. Many basketball players can continue to play with shin splints. However, the condition is quite frustrating. Essentially the tissue (periosteum) overlying the bone in the lower leg (the tibia) gets irritated and inflamed. This tissue irritation is believed to be due to the repetitive traction of the lower leg muscles that pulls on the periosteal tissue during the course of playing basketball. Symptoms are often improved with ice, anti-inflammatory medications, stretching, and stopping or limiting activities. It is often possible for players to “play through” painful shin sprints. However, if the condition becomes too debilitating it may be necessary for the player to stop playing for a period of time and add a formal physical therapy program in order to get the shin splint symptoms to resolve. In rare instances an aching pain in the shin can be secondary to as stress reaction or even a stress fracture of the tibia. A stress fracture is a more serious condition that does require basketball activities to stop until the microscopic fracture has healed adequately -often many weeks.
Jones Fractures
A stress fracture of the base of the fifth metatarsal is known as a Jones fracture. This injury is relatively uncommon, but seems to be more prevalent in basketball players. This is likely due to their large size, and the long lever arms associated with their large shoe sizes. In addition, these fractures are typically seen in individuals with high arched feet which when combined with a tight calf muscle can generate considerable repetitive loads through the outside part of the midfoot. This combination of factors leads to repetitive stresses on the base of the fifth metatarsal with can create a microscopic injury to the bone or even a complete stress fracture. Unlike most fractures which occur from a single injury, stress fractures such as a Jones fracture occurs from repetitive microscopic trauma. For this reason, patients will often have aching pain symptoms associated with the outside part of their midfoot prior to suffering a complete fracture. A Jones fracture can usually be diagnosed via an x-ray, Although in some instances an MRI will demonstrate edema and evidence of microfractures which are not seen on plain x-rays of the foot. Initial treatment of a Jones fracture involves stopping all activities and relatively immobilizing the foot, usually in a walker boot. Some Jones fractures can be treated non-surgically, although healing times may be slower and the recurrence rate is likely to be higher. However, many basketball players who suffer a Jones fracture will likely have this injury treated surgically with a screw placed through the center of the 5th metatarsal bone in order to stabilize the fracture site. Whether this injury is treated non-surgically or surgically patients may be at risk for recurrence if their underlying foot shape and alignment causes the outside of the foot to absorb a disproportionate amount of force when they are running and jumping.
Stress Fractures
Basketball players often run many miles in the course of a game. Furthermore, the sprinting and sudden change of direction activities create extraordinary repetitive loads through their feet and lower extremities. These forces can predispose to stress fractures in various areas of the foot and lower leg. Common areas for stress fractures include the metatarsals, the navicular, the base of the fifth metatarsal (Jones fracture), the tibia, and even the femoral neck. The location of a stress fracture will be dictated by how much force that area of anatomy is absorbing when the player is being active. Stress fractures are more common in players who have had a sudden increase in their activity level, or have weaker bones. Weaker bone may be a particular issue in female basketball players who have lost weight and stopped menstruating as these metabolic changes can lead to poor bone metabolism and a higher rate of stress fracture occurrence. Before a complete stress fracture occurs, the bone is usually subject to a stress reaction. A stress reaction of the bone is essentially a microscopic injury to the bone which will not be seen on x-ray, but will show up on an MRI. Treatment of a stress reaction or a stress fracture requires an accurate diagnosis, an appropriate period of Immobilization or relative mobilization to allow the bone to heal, correction of any metabolic risk factors, and then a very gradual return to sports. Unfortunately, a stress fracture often means that the player will be out of action for a considerable period of time while the fracture heals.
Injuries in basketball players often affect the foot and lower leg due to the incredible acute and repetitive forces that these areas are subject to. This has been a review of some of the common chronic and acute injuries that basketball players suffer. However, there is an almost unlimited variety of injuries that can occur to muscles, tendons, bones, joints, and even nerves. Taking the time to warm up well; gradually increasing playing time and activity levels; and allowing for adequate rest and recovery can all be helpful in minimizing the risk of injury in basketball players. However, the nature of the game of basketball and the players who play the game means that injuries will likely always be a risk of this dynamic sport.