Shock waves in the treatment of stress fractures

Ultrasound Med Biol. 2009 Jun;35(6):1042-9. doi: 10.1016/j.ultrasmedbio.2008.12.002. Epub 2009 Feb 25.


In soccer players, lower extremity stress fractures are common injuries and are the result of repetitive use damage that exceeds the intrinsic ability of the bone to repair itself. They may be treated conservatively but this may cause long-term complications, such as delayed union, muscle atrophy and chronic pain. Stress fractures that fail to respond to this management require surgical treatment, which is also not without risks and complications. Extracorporeal shock wave therapy (ESWT) has been used successfully on fracture complications, such as delayed union and nonunion. As such, we want to examine ESWT in the management of stress fractures. In this article, we present a retrospective study of 10 athletes affected by chronic stress fractures of the fifth metatarsus and tibia that received three to four sessions of low-middle energy ESWT. At the follow-up (8 wk on average), the clinical and radiography results were excellent and enabled all players to gradually return to sports activities. These reports show that ESWT is a noninvasive and effective treatment for resistant stress fractures in soccer players.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Fracture Healing
  • Fractures, Stress / diagnostic imaging
  • Fractures, Stress / therapy*
  • Fractures, Ununited / diagnostic imaging
  • Fractures, Ununited / therapy*
  • Humans
  • Male
  • Metatarsus / diagnostic imaging
  • Metatarsus / injuries
  • Radiography
  • Retrospective Studies
  • Soccer / injuries*
  • Tibial Fractures / diagnostic imaging
  • Tibial Fractures / therapy
  • Treatment Outcome
  • Ultrasonic Therapy / methods*
  • Young Adult