The Power Forward and the Exploding Shoe

Nowadays, when we see a headline about an “exploding shoe,” we instinctively think of an alarming situation involving the Transportation Security Administration—the TSA.

Thankfully, that was not the case at a memorable February 20 Atlantic Coast Conference basketball game between Duke and North Carolina.

Early on, Duke’s star power forward, Zion Williamson, was the victim of a wardrobe malfunction, you could say. Pivoting with his back to the basket, the 6-foot-7, 280-pound athlete planted his left foot and found himself in a compromised position. He quickly got unshod as his foot forcefully broke through the lateral aspect of a Nike Paul George-PG 2.5 basketball shoe. At the same time, Williamson’s right knee collapsed medially into a grade-1 sprain.

The star player’s injury isn’t serious, but the incident has raised a great deal of speculation. Was the shoe faulty? Close-up replay of Williamson’s move showed that it failed at the interface of midsole and outsole. Or was it just the wrong shoe for this athlete?

By Robert M. Conenello, DPM

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3 Can Be Better Than 6 When It Comes to Weber B Fractures

In medical school, we were taught that Weber B ankle fractures required the 6-week cast immobilization protocol. But for many of us, that protocol has felt excessive due to concerns of increased ankle stiffness, decreased ankle strength, and the possibility of a thrombotic event. However, the thought of possible suboptimal healing of the fracture [malunion or nonunion] with less than 6 weeks of immobilization or use of less rigid forms of immobilization provided anxiety to many of us treating physicians. Despite the anxiety, there has been a trend among foot and ankle physicians toward earlier mobilization for this common fracture subset.

And now, a recent article¹ in the British Medical Journal has arrived to soothe that anxiety. The Finnish study reported on the comparison of immobilization techniques for stable unimalleolar Weber B ankle fractures.

This well designed, randomized, blinded, and high patient number clinical trial provides excellent clinical evidence for the decision to treat stable unimalleolar Weber B ankle fractures with options other than long-term immobilization of up to 6 weeks. In the study, patients were randomized into 3 groups: a 6-week cast group (84), a 3-week cast group (83), and a 3-week orthosis group (80). The 6-week cast group served as a control group and the authors compared the 3-week cast group to the 6-week cast group and the orthosis group to the 6-week cast group. The authors were looking to see if treatment of these fractures with immobilization in a cast for 3 weeks or immobilization with the use of an orthosis for 3 weeks produced non-inferior results as compared to 6 weeks of cast immobilization. Study participants were seen at 3 weeks, 6 weeks, 12 weeks, and 52 weeks. The study results showed that 3 weeks of cast immobilization or 3 weeks of immobilization with the use of a prefabricated ankle-foot orthosis provide the same clinical outcome as immobilization of 6 weeks with a cast for these fractures. This is the result of enhancement of fracture healing with early mechanical stimulation.

By Jeffrey R. Baker, DPM, FACFAS