Early detection reduces threat of foot injury in college basketball players

December 01, 2004

Durham, N.C. -- Early identification of potential stress fractures with magnetic resonance imaging (MRI) can reduce the threat of season-ending injuries for college basketball players, according to a Duke University Medical Center radiologist.

The findings -- based on the study of 26 male college basketball players -- suggest that such diagnostic work should perhaps be included as a standard part of physical examinations for male and female basketball players, who regularly place considerable stress on their feet, said Duke radiologist Nancy Major, M.D. Other athletes whose sport or training regimen puts similar stresses on bones of the feet might also stand to benefit from the MRI evaluation, she added.

Further study is warranted to consider the policy implications of such a practice, she added. The MRI screening would not be recommended for people who participate in such sports on a casual or more limited basis.

"When diagnostic work is conducted pre-season, at-risk players are more likely to be identified, receive treatment and ultimately play the entire year instead of losing eight to 12 weeks on the bench," Major said.

Major presented her findings at the annual meeting of the Radiological Society of North America in Chicago on Dec. 2, 2004.

A stress fracture is a small crack in a bone brought on by overuse or repeated impact on a hard surface over a long period of time, Major said. The muscles that absorb the shock of the impact eventually become fatigued, diverting much of the stress to the underlying bone. If the injury goes undetected, more serious stress fractures can occur, resulting in chronic problems or the need for surgery. For top college athletes, such an injury can mean the end of a season or even of a career, she added.

"Stress fractures of the foot are extremely common in college basketball players," Major said. "The combined repetitive jumping and landing required of players often results in these injuries, causing players to be benched during the long recovery period." Each year, several National Collegiate Athletic Association (NCAA) male basketball players typically suffer stress fractures of the fifth metatarsal - the foot bone most vulnerable to stress fracture, Major noted.

An abundance of fluid known as bone marrow edema frequently precedes fractures of the fifth metatarsal, which runs from the mid-foot to the base of the small toe, she explained. Signal abnormalities on an MRI highlight the edema before fractures become symptomatic.

The study examined 26 college basketball players prior to the 2003 NCAA season. Only one of the 14 male players from Duke University and 12 from North Carolina Central University exhibited symptoms prior to examination.

Of the 52 feet studied via MRI, 19 (36.5 percent) exhibited some form of abnormality, ranging from soft tissue changes in joint areas to abnormalities of the metatarsals, Major reported.

Based on the MRI findings, physicians provided custom-fit shoe supports and other external bracing devices known as orthotics, as well as other therapies, to prevent injury in two athletes. One player included in the MRI study avoided surgery through a combination of supports and bone stimulation, Major said. Adjustments to an existing orthotic provided immediate relief for a second player who had pre-existing symptoms. A third player developed a stress fracture before he could be fitted for a support.

Earlier research at Duke found that such preventative action appears to relieve the constant stresses and pressures suffered by the fifth metatarsal, thereby preventing further debilitating injuries. Orthotics may also prevent existing stress fractures from becoming complete fractures, Major added.

"By looking at athletes individually with MRI, physicians can evaluate, institute appropriate therapy and document potential problems for further evaluation," Major said.
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Duke University Medical Center

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