What Is a Bone Stimulator?

A bone stimulator is a medical device that uses low-level energy—either low-intensity pulsed ultrasound (LIPUS) or electrical stimulation—to accelerate bone healing. These devices are used adjunctively (alongside standard treatment) for fractures that are healing slowly, non-unions (fractures that have failed to heal after the expected timeframe), and after surgical bone fusions (arthrodesis) in the foot and ankle to improve fusion rates. They are non-invasive and used by patients at home, typically daily for prescribed durations.

Bone stimulators are not a replacement for proper fracture fixation, immobilization, or nutrition—they are adjuncts that augment the body’s existing healing response. The evidence supporting their use is strongest for delayed unions (fractures taking longer than expected to heal) and established non-unions. Their role in routine acute fracture care is more debated but is supported by some evidence, particularly in high-risk patients (smokers, diabetics, patients with poor vascularity).

Types of Bone Stimulators

Low-Intensity Pulsed Ultrasound (LIPUS)

LIPUS devices (the most commonly prescribed brand is Exogen by Smith+Nephew) use low-level ultrasound waves to stimulate bone-forming cells (osteoblasts) and promote the biological cascade of bone healing. The device is applied directly to the skin over the fracture site with ultrasound coupling gel for 20 minutes daily. LIPUS has the most robust evidence base among bone stimulation modalities, with randomized controlled trials showing acceleration of fracture healing time by approximately 38–50% in fresh fractures and improved union rates in delayed unions and non-unions. It is FDA-approved for fresh fractures and non-unions.

Electrical Bone Stimulators

Electrical stimulation devices (capacitive coupling, inductive coupling/pulsed electromagnetic fields/PEMF, or direct current) stimulate bone healing through electromagnetic effects on bone cells. PEMF devices (such as those made by Orthofix) are commonly used for non-unions and post-surgical fusions, worn around the limb for several hours daily. They are FDA-approved for non-unions and have good evidence for improving fusion rates in spinal, foot, and ankle arthrodesis procedures—particularly in patients at elevated risk for non-union (smokers, diabetics, patients with revision surgery).

When Are Bone Stimulators Used in the Foot and Ankle?

Stress Fractures

High-risk stress fractures—particularly navicular stress fractures, Jones fractures (proximal 5th metatarsal), and sesamoid stress fractures—have notoriously slow and sometimes incomplete healing. LIPUS can be prescribed alongside non-weight-bearing immobilization to accelerate healing and reduce the risk of fracture progression to complete fracture. Some surgeons incorporate bone stimulation into the standard protocol for high-risk stress fracture locations to reduce time to return to activity.

Surgical Fusions (Arthrodesis)

Ankle fusion, subtalar fusion, midfoot fusion, and 1st MTP joint fusion all require reliable bone healing across the arthrodesis site for the procedure to succeed. Non-union rates for foot and ankle fusions range from 5–20% depending on the joint and patient factors. For high-risk patients—active smokers (who have significantly impaired bone healing), poorly controlled diabetics, patients undergoing revision surgery or fusion with poor bone contact—bone stimulators are often prescribed post-operatively to improve fusion rates. Evidence supports PEMF and LIPUS for improving arthrodesis rates in high-risk patients.

Non-Unions

A non-union is a fracture that has failed to heal after the expected timeframe (typically 6 months for a fracture that should heal in 2–3 months). Non-unions in the foot most commonly occur at the 5th metatarsal (Jones fracture zone), the navicular, and at fusion sites. Treatment of established non-unions typically requires surgical intervention (re-fixation, bone grafting), but bone stimulation is often added as an adjunct and is FDA-approved for this indication. In some cases of early delayed union without significant fracture gap, bone stimulation combined with continued immobilization may achieve healing without surgery.

Who Should Use a Bone Stimulator?

Bone stimulators are appropriate for: high-risk fractures at locations prone to non-union (navicular, Jones, sesamoid), established delayed unions (fracture slower than expected to heal), non-unions, post-operative fusion procedures in high-risk patients (smokers, diabetics), and revision fusion surgeries. They are not routinely indicated for straightforward acute fractures expected to heal normally in healthy patients—the marginal benefit in uncomplicated fractures is smaller and cost-effectiveness is less clear. Your podiatrist will prescribe a bone stimulator when the clinical picture supports its use.

Frequently Asked Questions

Is a bone stimulator covered by insurance?

Most major insurance plans, including Medicare, cover bone stimulators when medically necessary for FDA-approved indications—specifically non-unions (fractures that have not healed after 3–6 months of appropriate treatment) and delayed unions in specific fracture types. Coverage for use in acute fresh fractures or post-surgical fusion prophylaxis varies by payer and requires prior authorization with documentation supporting the medical necessity. Your podiatrist’s office will handle the prior authorization process and verify your coverage before prescribing a device. Out-of-pocket costs for uncovered use can be significant ($1,000–$3,000 for device rental), which is why insurance verification is important.

How long do you need to use a bone stimulator?

Treatment duration depends on the indication and device type. LIPUS (Exogen) is typically prescribed for 20 minutes daily for the duration of healing—commonly 3–6 months, with imaging used to confirm healing progress. PEMF devices are worn for several hours daily and may be prescribed for 3–9 months for non-unions. Compliance is important: bone stimulators require consistent daily use to be effective. Clinical trials that demonstrate efficacy are based on compliant use. Most devices have built-in compliance monitors that track usage, which is important for insurance purposes (some payers require compliance data at follow-up visits).

Can I speed up bone healing naturally?

Several factors support optimal bone healing: adequate calcium (1,000–1,200mg daily) and vitamin D (1,000–2,000 IU daily, or correcting documented deficiency) are essential for bone mineralization. Protein intake supports fracture healing—patients healing fractures have higher protein requirements. Avoiding smoking is critical—nicotine significantly impairs bone healing by reducing blood supply and osteoblast activity; the risk of non-union is 2–3 times higher in smokers. Avoiding NSAIDs (ibuprofen, naproxen) in the first 4–6 weeks after fracture may improve healing, as these medications inhibit prostaglandins involved in early fracture healing. Good diabetic control (HbA1c below 8%) dramatically improves healing in diabetic patients.

Medical References & Sources

📧 Get Dr. Tom’s Free Lab Test Guide

Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.

Download Your Free Guide →

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He prescribes bone stimulation devices for appropriate patients with delayed unions, non-unions, high-risk stress fractures, and complex surgical fusions to optimize healing outcomes.

Join 950,000+ Learning About Foot Health

Dr. Tom shares honest medical advice, supplement reviews, and treatment guides you won’t find anywhere else.

Subscribe on YouTube →

📍 Located in Michigan?

Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.

Book Now → (810) 206-1402