Emerging Options for Biologic Enhancement of Stress Fracture Healing in Athletes

Timothy L. Miller, MD; Christopher C. Kaeding, MD; Scott A. Rodeo, MD


J Am Acad Orthop Surg. 2020;28(1):1-9. 

In This Article

Extracorporeal Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) is a noninvasive topically applied modality that has been used by sports medicine orthopaedic surgeons and podiatrists for the treatment of overuse injuries of soft tissues and bone since the late 1980s.[43–45] The therapeutic basis of ESWT lies in its ability to use mechanotransduction to stimulate osteoblast formation, bone turnover, and increased local angiogenesis.[43] Furia et al[46] have reported its success rates for treatment of stress fracture delayed unions and nonunions in military personnel to be equal to those of surgical repair with minimal risk for complications. Other authors have indicated extended time to healing and a high likelihood of requiring internal fixation in addition to the use of high-intensity ESWT.[44] The results in the literature are mixed but it can be considered as an adjunctive treatment for refractory stress fractures showing radiographic indication of delayed healing.