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    • 29 FEB 16
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    The feet of mud of Gasol brothers

    The feet of mud of Gasol brothers


    The 12 recommendations to avoid the stress fracture of the foot

    The brothers Pau and Marc Gasol are players of basketball at the maximum level in the NBA (American league). Both have suffered complex injuries of the foot in important moments of his sportive career. Pau was in the 2006 World Championship, one of the highests moments of his career. Marc has been now. The stress fracture of the metatarsian bone is a predictable pathology, of slow curing, that warns and that it is undervalued in annoying occasions.
    Pau (215 cm, 115 kg) was playing the semi-finals of the 2006 World Championship (26 years old) when in an attack injured the foot in the final step below the basket. It had not fallen neither twist, simply in a normal step. I remember to see the image on TV and think in a stress fracture because there was not traumatism. He was driven to the Clinic Kato of Saitama (Japan) where was done the diagnostic that would do him loose the final. His team players but would help him to win the medal of gold in that World Championship.

    Marc, with his 216 cm (120 kg, at present 31 years), player of the Memphis Grizzlies, already presented previous pain in the zone as a consequence of small cracks that warn of the possibility of the fracture, but the physiotherapists of Memphis ignored it. Until it broke the bone. Then it was visualises for X-ray and resonance in the Clinical Campbell of Memphis an injury that would have to be diagnosed before. It is in doubt if he will be able to play the Olympic Games of Rio (August), since they are fractures that recover between 3 and 6 months. The season of Marc with 16.6 points/game and as he says he “struggling to the maximum” brought to his foot to a level of high demand for his bone.

    How it is that they repeat injuries and patterns? There are 3 zones of special weakness to the foot: the neck of the 2nd and 3rd metatarsal bone and the metaphysodiaphysal area of the 5th metatarsus of the foot, that is the zone with more risk for the difficulty of bone irrigation. The top-level basketball players has 3 risk factors: 1) Overhead Weight. Each one of the Gasol foot has to support around 60 kg of weight. 2) Repeated overload efforts. It sees in basketball players of competitions very demanding like the NBA (2-3 games each the week) or in runners of marathons and ultramaratons. 3) Changes in the form of the foot with the years. It produces a change of the footstep as a consequence of the increase pronation due to the insufficiency of the ligaments and tendons of the medial part and base of the foot.

    There are several behaviours that can do to avoid it. We highlight twelve preventive measures: 1. They are necessary some personalized plantar supports, dynamic, resistant (the carbon fibre and the new foams in different combinations appears to be the new materials with more resistance, 3D Scan Sport, www.podoactiva.com) and with memory, that have to renew every year or each 2 years. 2. Annual studies of the walk pattern (studies of podobarometry and biomechanics). There is alteration in the walking pattern corrections. 3. Precocious detection of possible risks. The resonance or the scintigraphy has a very important rule in this prevention. 4. Avoid the overweight. Marc had reached 155 kg. Now he has 120 kg and these injuries are more difficult. 5. Exercises of strengthening of ankles and feet: Bosu, Theraband, closed chain, …. 6: Avoid the hardest and traumatic surfaces (asphalt, track,…). 7: Shock absorber footwear. Avoid the hard studs in zones of risk in the football player (injury that suffered Messi) and have a footwear with inner shock absorber surfaces (in the case of Marc lately the Nike Hyperdunk). 8: Avoid the fatigue of muscular groups of the foot for routine exercises. They have to be varied and intermittent exercises. 9: Good feet hygiene. Have to avoid sores or other injuries that they are painful and change the type of walking. 10: Increase of gradual shape the intensity, distances and time of trainings. No more than a 10% weekly. Especially important in the period of recovery of stress fractures. 11. Measure the vitamin D levels or colecalciferol in blood. Especially important in sports of interior in pavilions (the basketball is it) and in cold climates. A low level of vitamin D predisposes to stress fractures and difficults its healing. 12. Avoid the vegetarian diets 100% (to be low in proteins) and also avoid the low diets in calcium.

    But once the injury is present we have to remember: to keep the muscle volume to facilitate the return (can do with sports that are not of load: swimming, gymnasium, cycling,..), the surgery saves time of recovery and the stress fracture needs rest at first and very progressive back return (10% weekly and a period of stabilisation attained to 50%). We have to do prevention in the other foot because until a 25% can be bilateral.
    In definite, the feet of Pau and Marc need more prevention, personalized treatments, studies with 3D Scan Sport, control of the weight, control of the diet, use the new materials for feet supports, tendon and muscle strengthening of the foot and ankle stabilizers, avoid overloads (no official games,…), measure vitamin D levels and progressive coming back. In definite, this is the main risk for his professional careers than taking care all these details will be able to be much longer and successful.



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