Stress fractures
CONSULT TREATMENT PROTOCOL
INDICATIONS
GLOBAL INDICATIONS
Tendon disorders
- Calcifying tendinitis of the shoulder
- Chronic distal biceps tendinopathy
- Chronic proximal hamstring tendinopathy
- Golfer’s elbow
- Greater trochanteric pain syndrome
- Insertional Achilles tendinopathy
- Medial tibial stress syndrome
- Mid-body Achilles tendinopathy
- Patella tip syndrome
- Plantar fasciopathy
- Primary long bicipital tenosynovitis
- Subacromial pain syndrome
- Tennis elbow
BACK
GLOSSARY OF DISEASES
BACKMORE INFORMATION
A stress fracture is defined as a small crack in a bone. Some authors have also considered severe bruising within a bone as stress fracture. Stress fractures are usually the result of overuse and repetitive activity.
Because the weight-bearing bones of the foot and lower leg must absorb the high repetitive forces involved in walking, running and jumping, these bones are especially vulnerable to stress fractures. They are common in soccer and basketball players as well as in runners. Very often, stress fractures occur when athletes change their activities or suddenly increase the intensity of workouts. Stress fractures may also occur during normal daily activities when certain diseases (such as osteoporosis) impair normal bone integrity.
The bones most often affected by stress fractures are the tibia, the fibula, the second and third metatarsals in the foot, the calcaneus (heel), the talus (a small bone in the ankle joint) and the navicular (a bone on the top of the midfoot). The key to recovery from a stress fracture in the foot or ankle is to refrain from high impact activities for an adequate period of time. If patients suffering from a stress fracture fail to do this, the healing process may be delayed and ultimately, the affected bone may break completely.
Extracorporeal shock wave therapy (ESWT) was introduced as treatment for stress fractures in 2009 (Moretti et al., Ultrasound Med Biol 35:1042-1049).
However, prospective, controlled trials on ESWT for stress fractures have not yet been published.
CLINICAL EVIDENCE
Clinical trials confirming the effectiveness and safety of radial shock wave therapy (RSWT®) using the Swiss DolorClast® device for stress fractures are currently underway.
Pre-published data indicating that RSWT® is effective and safe in the treatment of stress fractures is based on (i) anecdotal reports by many users of RSWT®, (ii) the proven effectiveness and safety of RSWT® for fracture nonunions of superficial bones (Silk et al., Foot Ankle Int 2012;33:1128-1132; Kertzman et al., J Orthop Surg Res 2017: in press), (iii) the finding that radial shock waves generated with the Swiss DolorClast® device (RSWs) induced new bone formation in an animal model in vivo (Gollwitzer et al., Ultrasound Med Biol 2013;39:126-133) and (iv) the finding that RSWs induced proliferation of human osteoblastlike cells in vitro (Diaz-Rodriguez et al., Adv Sci Lett 2012;17:325-329).
TREATMENT PROTOCOL
| Number of treatment sessions | 3 to 5 |
| Interval between two sessions | 1 week |
| Air pressure Evo Blue® | 2 to 3 bar |
| Air pressure Power+ | 1.5 to 3 bar |
| Impulses | 2,000 to 3,000 on the painful spot |
| Frequency | 8Hz to 12Hz |
| Applicator | 15mm |
| Skin pressure | Light to moderate |
