Orthopedic Associates – Dr. David Waters on Basketball Season


When winter comes basketball season starts. I love basketball season whether it’s the rush of the court, the jump shot, the exciting slam dunk or the fast-break. I love watching basketball! When I was a kid I used to love to play basketball and would play once a week with my friends at the local church. This basketball season is particularly exciting for me as I started coaching my third-grade son in the Boys and Girls Club basketball league. Coaching second and third graders is nothing like coaching high schoolers. The kids are still learning to dribble, pass, and shoot and have no understanding of coordinated team play. It’s exciting to watch them grow in their skills and knowledge of the game.

With basketball season comes basketball injuries. As I watch these little ones that I’m coaching run around the court I can’t help but also be a little worried about the injuries that might be sustained. Some of the most common basketball related injuries include sprained ankles, fractured ankles, fractures of the foot, Achilles tendon injuries, overuse injuries such as tendinitis, and plantar fasciitis.

The following is little bit of helpful information to consider during this basketball season.

1. Ankle Sprains: Ankle sprains are by far the most common basketball related injury of the foot and ankle. Most ankle sprains are the inversion type of ankle sprains. Inversion sprains mean that the foot rolls inward. Sprains most commonly happen when somebody lands awkwardly on the outside part of their foot, lands on top of somebody else’s foot, or has his or her foot stepped on while trying to move. Inversion ankle sprains most commonly result in sprain and/or strain of the anterior talofibular ligament (the weakest of the ankle ligaments) which prevents anterior translocation of the talus within the ankle joint. However the calcaneal fibular ligament, and posterior talofibular ligament can also be strained or sprained. Other ligaments that may be damaged in an ankle sprain injury include the deltoid ligament complex medially and the syndesmosis which runs between your tibia and fibula. When the syndesmosis is disrupted this is the term that is referred to by the media as a high ankle sprain. The severity of the ankle sprain depends on how many ligaments have been disrupted and thus the instability of the ankle joint. Simple grade 1 ankle sprains where all that is disrupted is the anterior talofibular ligament can often be treated with just rest, ice compression and a sturdy ankle brace while the athlete continues to play. With greater disruption of the ligament complex that stabilizes the ankle there will be greater time loss to the athlete. High ankle sprains where all ligamentous structures are disrupted lateral, medial and syndesmosis can often take several weeks of non-play and offloading in a walking boot for complete healing. All ankle sprain injuries should be evaluated by one of Orthopedic Associates P.A. Foot and Ankle Specialist/Podiatrist.

2. Ankle Fracture: Another common injury associated with basketball is ankle fracture. Although not an ankle fracture, no one who has seen the video can forget Louisville guard Kevin Ware’s open tibial fracture. Fracture of the ankle may involve fracture of the fibula, the fibula and the tibia, the fibula and the tibia and associated soft tissue structures. Ankle fractures are most often a result of rotational type forces. These are common forces associated with the game of basketball as players run, jump, twist, and pivot on their feet in order to gain advantage. Ankle fractures range from simple lateral malleolus non displaced fractures to complex comminuted displaced fractures. Regardless of the type of fracture, time loss to play can vary in the 6 to 10 week range or greater to allow for adequate bone healing. Displaced comminuted complex ankle fractures and sometimes simple displaced lateral malleolus fractures may require surgical intervention with plates and screws. Orthopedic Associates P.A. Foot and Ankle Surgeon/Podiatrist can evaluate and treat these injuries.


3. Achilles Tendon Injuries: A few months back the Detroit Pistons point guard Brandon Jennings ruptured his Achilles and two seasons ago Kobe Bryant did as well. The Achilles tendon is the strongest tendon in the body. It originates as part of your calf muscle and inserts onto the heel bone (calcaneus). The Achilles tendon is utilized in basketball for jumping running and forceful push off against the ground. Injuries to the Achilles tendon can result from overuse. Most common Achilles overuse injury is tendinitis. Tendinitis may be insertional tendinitis where the Achilles inserts on the calcaneus. You may also have Peritendinitis which is inflammation around the tendon itself. Symptoms associated with peritendinitis are pain along the course of the tendon, or pain with use of the tendon. Symptoms associated with insertional tendinitis is pain at the insertion of the Achilles tendon at the posterior superior aspect of the calcaneus, also pain with heel lift exercises and with ascending or descending flights of stairs. Overuse injuries can often be managed while the athlete continues to play. This can often be done by simply inserting lifts into the athletes shoe to relieve tension on the Achilles tendon. Also good treatments like rest, ice, compression and appropriate stretching and strengthening of the Achilles tendon will help.

More serious Achilles tendon injuries involve partial and/or full rupture of the Achilles tendon. Just earlier this year I had a patient with a complete rupture of his Achilles tendon after forceful push off against the ground during a basketball game. Complete rupture usually happens at the watershed area of the Achilles tendon where blood supply is less optimal. This area lies approximately 2 to 3 cm superior from the insertion of the Achilles tendon. Complete rupture in most cases requires surgical repair of the Achilles tendon. It also results in significant time lost from play and significant rehabilitative time after repair of the tendon. Partial ruptures can sometimes be managed non surgically with offloading of the tendon to allow for appropriate time for healing. However some partial ruptures will require surgical repair. All full and partial ruptures of the Achilles tendon should be evaluated by one of Orthopedic Associates P.A. Foot and Ankle Specialist/Podiatrist.

4. Planter Fasciitis: Plantar fasciitis is a chronic overuse injury to the plantar fascial band that runs from your heel to your toes on the bottom of your foot. This overuse injury is most often associated with hyper pronation (flattening of your arch) of the foot. It can also be associated with equinus which is decreased range of motion at your ankle joint due to a tight calf muscle and achilles tendon. It is due to small tears in the plantar fascial band that are not given adequate time for healing. Most common symptoms associated with plantar fasciitis are post-static dyskinesia this simply means in normal English, pain in a certain body area (in this case your foot) after periods of rest when activity is resumed. For most people this is noticed as pain in their foot upon getting out of bed in the morning. However it can also be associated with pain upon standing after any significant period of rest. Pain is usually localized to the bottom of the foot near the heel. Pain can be very significant especially if not treated and not given adequate time for healing. Treatment for plantar fasciitis consist of control of the inflammatory response of the body this can be done with steroid injections, ice and heat, compression dressings, and oral over-the-counter anti-inflammatory drugs. The mainstay of therapy for plantar fasciitis involves disciplined home or formalized physical therapy regimen which involves daily calf stretches and exercises. Other devices that might be utilized for treatment of plantar fasciitis involve night splints and/or orthotics. Long-term management of someone who suffers with plantar fasciitis will involve increasing range of motion at the ankle joint through physical therapy exercises whether formalized or at home, management and control of the motion and kinematics of the foot; this is most often accomplished with orthotic therapy. When plantar fasciitis is appropriately recognized and treated by a Foot and Ankle Specialist or Podiatrist most cases can be resolved with nonsurgical treatment. Patients should not delay in presentation to Orthopedic Associates P.A. Foot and Ankle Specialist/Podiatrist if symptoms are suggestive of plantar fasciitis. Early recognition and treatment will lead to more optimal outcomes.


Below are some recommendations for avoiding foot and ankle injuries and athletic events:

1. Appropriate warm-up time and stretching should be observed prior to the participation in the athletic event.

2. When appropriate taping of ankle joints and/or wearing of external ankle braces should be employed. Recent studies have shown that the amount of sprains and the severity of sprains were decreased with the use of bracing. In the event you do not know how to tape an ankle or what type of brace to obtain evaluation by one of Orthopedic Associates P.A. Foot and Ankle Specialist/Podiatrist would be of great benefit. They also work with the athletic trainers of the local high schools in the area.

3. Appropriate cool down and recovery should be employed under the supervision of an athletic trainer and/or a physician if questions arise.

4. Appropriate shoe gear and or orthotics should be utilized when participating in athletic events. This may require evaluation of foot type and/or gate evaluation to ensure the best type of gear for the athlete.

Basketball is one of the greatest games on the face of the planet. It requires coordination, balance, athleticism, and understanding. Those who excel in the game of basketball perform amazing feats that we all like to watch. However injury can sideline those who enjoy playing both recreationally and competitively for a significant amount of time. Care should be taken to avoid injuries at all costs without delaying or suspending participation in the activity.

The four corners community is fortunate to have two world-class Foot and Ankle specialist/Podiatrist (Dr. Larry Ward, DPM and Dr. David Waters, DPM) available to assess and treat all conditions associated with the foot and ankle. This includes injury to the foot and ankle sustained while participating in the sport of basketball. The foot and ankle specialists at Orthopedic Associates PA have both completed four years of podiatric medical schooling, three years of advanced foot and ankle surgical training including the treatment of sports injuries and recognized by the American Board of Foot and Ankle Surgery. They are experts in the treatment and evaluation of all conditions related to the foot and ankle.

If you have any questions about how to enhance your performance and safety in this sport or any other sport please come and see one of Orthopedic Associates P.A. Foot and Ankle Specialist/Podiatrist.