Feb. 7, 2006

J. Marc Davis, PT, ATC
University of North Carolina

The foot and ankle complex is a marvel of biomechanical engineering. It can adapt to hard and soft surfaces, change from a rigid lever for propulsion to a supple shock absorber, and transmit forces up and down the entire body. But despite being able to do all this, a certain amount of stability is sacrificed leaving the ankle susceptible to injury. As a result, ankle injuries are a fact of life in basketball and in fact, ankle sprains are the most common injury. Fortunately, there are certain interventions that can reduce the likelihood of ankle injury although nothing short of complete inactivity will completely prevent injury.

Shoe Selection: Historically, high top basketball shoes have been recommended to prevent ankle injury but most modern basketball shoes are now three quarter height and are considered neither high top nor low cut shoes. Regardless, research shows that it is the condition and quality of the shoe that helps prevent injury, not the height. A well made shoe that fits the foot properly and has a firm heel counter is the best choice.

Taping and Bracing: Does taping or bracing a healthy ankle prevent injury? The research is mixed but most college and professional teams require some form of extra protection. One old study showed that basketball players wearing high top shoes and tape were less likely to sprain their ankles than those wearing low cut shoes and no tape. Taping and bracing will not cause a healthy ankle to weaken and is extremely helpful in returning an injured athlete to competition. Taping the ankle is a learned skill that requires a certain amount of practice and can be quite expensive over the course of a season but can be very comfortable and supportive when done effectively. Bracing is an easy way to provide extra support and research shows it can be just as effective as tape. There are two basic kinds of ankle braces available; soft lace up braces with supportive straps and hard plastic shell braces. The hard plastic braces provide the most support but tend to cost more and to be less comfortable and less cosmetically acceptable to athletes than the soft braces.

Flexibility: Reduced mobility at the ankle is associated with injury especially decreased dorsiflexion (the ability to pull the foot up toward the body). Calf/Achilles stretching should be part of every warm up and cool down session and for athletes with extremely tight Achilles a specialized program of flexibility may be needed.

Balance: Good balance is important to help keep the body and the foot/ankle away from positions/postures that place the ankle joint at risk for injury. The athlete should work on both single leg and double leg balance and especially balancing while landing. Young basketball players should be taught to land on two feet with the knees slightly flexed whenever possible.

Orthotics: There is evidence to suggest that athletes with extremely high arches or extremely flat feet are susceptible to ankle sprains. A qualified health professional can help determine if orthotics may be needed.

Playing Surface: The quality of the surface of the basketball court can have a profound effect on the likelihood of an injury. Obviously any wet sports caused by perspiration need to be immediately cleared, but also the surface should be inspected prior to competition to be certain it is clean and dust free. Dirt, dust, and old worn floor finishes can all affect the way the shoe grips the floor and can lead to injury if not addressed. Out of door courts should be clear of any debris and have a smooth even surface.

Preventing Re-injury: A good rehabilitation program is essential following injury to safely and quickly return an injured athlete to competition. There is no such thing as a simple sprain; just some are more severe than others. Any injury can become debilitating if proper care is not provided. The goal following injury is for the athlete to as quickly and safely as possible regain normal strength, range of motion, balance, function. If an injured athlete returns too soon the chance of re-injury is high and so is the possibility of developing tendonitis or even joint instability. Your physician, athletic trainer, or physical therapist can assist in planning an appropriate rehabilitation program.

It is not possible to prevent all ankle injuries but the above interventions can help reduce the likelihood of injury. Good shoes, good flexibility and balance, braces and orthotics if appropriate, and a safe playing surface are all important in preventing injury. Rehabilitation is crucial in preventing re-injury and any negative long term effects from the injury.