Addressing A Recurring Fifth Metatarsal Stress Fracture, Part 2: Do The Shoes Affect The Outcome?

Last month, I talked about an NBA athlete with recurrence of a fifth metatarsal fracture in the left foot.¹ I discussed how I modified his orthotics to decrease the pressures under the fifth metatarsal to relieve his discomfort and hopefully to decrease his risk of re-injuring that metatarsal for a third time.

This month, I am going to also discuss the potential risks that three different basketball shoes had on his injured fifth metatarsal.

Pictured are in-shoe pressure images of three of the shoes that the team and the NBA player had me test. He had a shoe preference but was open to switching if there was a shoe that would work better for him.

As you can see from the images, there are pretty distinct differences in the pressures at the lateral column between all the shoes, which just all happened to be Nikes. The Nike Air Max shoe increased pressures under his fifth metatarsals bilaterally and especially under the left foot. The Jordan 2s and 10s had much lower pressures at the fifth metatarsal, but for some reason, the Jordan 10s caused some dysfunction in his gait. You can see that by observing the late start on the left foot with the center of pressure line. This happened with the Jordan 10s in multiple steps. I suggested that he avoid wearing those shoes or the Airmax shoes, and instead go with the Jordan 2s.

As you can see, three different shoes from the same manufacturer all functioned very differently for one individual NBA player with the same modified orthotics in each shoe. I think this is a very important thing for practitioners to appreciate: shoes can make a big difference whether we use custom foot orthotics or not. I think it is important for us all to understand that we can’t really know “what’s under the hood,” so to speak, with different athletic shoes. By this, I mean we can only see the surface of most athletic shoes and because we rarely get enough information on the overall build of a shoe, it makes it hard for anyone to make a very specific recommendation on how a shoe will work for an individual athlete.

I also want eveyone to understand that you really cannot know how a shoe will affect an athlete unless you use in-shoe pressure to test the functionality of that shoe. If we had not done this for this player, despite modifiying his old orthotics and getting him new ones with the better prescription, he might still have had issues from wearing the Nike Air Max shoes.

Please understand that I have nothing against Nike or any other shoe brand. Athletes will wear what they want, regardless of what I tell them or what their team tells them. Many of them get shoe contracts so this obviously confuses the situation for everyone and it is just part of the business.

In conclusion, I want you to appreciate that different shoes can and will have different effects on individual athletes. It is almost impossible to know if the shoe is part of the problem without using some sort of in-shoe pressure mapping system to test them. Not all shoes are an issue of course. But if you are going to work with high-level professional athletes, I think it is always better to be safe than sorry.

Finally, there are certain things I look for in shoes that I think definitely improve outcomes with orthotics and overall patient outcomes as well. We can discuss that next month. Until then, Happy New Year!

Reference

1. Williams B. Addressing recurrence of a fifth metatarsal fracture with orthotic modifications. Podiatry Today DPM Blog. Available at https://www.podiatrytoday.com/blogged/addressing-recurrence-fifth-metatarsal-fracture-orthotic-modifications . Published Dec. 19, 2018.