A fifth metatarsal base fracture is common in athletes and is often difficult to treat. Refractory cases are often managed surgically with screw fixation or bone grafts, but such procedures are extremely invasive. Recently, positive results have been reported from the use of extracorporeal shock wave therapy (ESWT) for stress fractures or delayed fracture union. We report on our experience with ESWT used in five cases of refractory fifth metatarsal base fracture where bone union had not been achieved at 12 weeks after initial treatment.
The patients included three males and two females, with a mean age of 19.2-years. The athletes were engaged in the following sporting disciplines: soccer (n = 2), basketball (n = 2), and track and field (long jump; n = 1). Mean duration of symptom before ESWT was 7.4 months. ESWT (Epos Ultra®, manufactured by Dornier MedTech) was performed 3500 shocks per round of treatment were applied at an energy density of 0.36 mJ/mm2 (total 1300 mJ), with the shocks targeted at the point of most intense pain.
Bone union was achieved in all five patients. Mean time to bone union was 11.2 weeks (7-16 weeks). Refracture occurred in one patient, but ultimately bone union was achieved with additional ESWT and the patient was able to resume sporting activities.
ESWT appears to be a safe and effective treatment option for refractory fifth metatarsal base fracture.