When Foot Fractures Don’t Heal

Most foot and ankle fractures heal predictably within 6-12 weeks. However, some fractures — particularly fifth metatarsal Jones fractures, navicular stress fractures, sesamoid fractures, and fractures in diabetic or vascularly compromised patients — are prone to delayed union (slow healing) or non-union (failure to heal). Bone stimulators are a non-invasive or minimally invasive technology that can accelerate healing in these challenging situations.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we prescribe bone stimulation therapy when appropriate to optimize healing and minimize the need for more invasive interventions.

How Bone Stimulators Work

Bone stimulation uses either electrical or ultrasonic energy to enhance bone healing at the cellular level. Electrical bone stimulators work through two mechanisms: pulsed electromagnetic field (PEMF) devices generate time-varying magnetic fields that induce weak electrical currents in bone tissue, stimulating osteoblast (bone-building cell) activity; capacitative coupling (CC) devices place electrode pads on the skin and pass a weak direct electrical current through the fracture site. Ultrasound bone stimulators (most commonly the EXOGEN device) deliver low-intensity pulsed ultrasound (LIPUS) — brief, repeated cycles of high-frequency sound waves that mechanically stimulate bone repair cells and accelerate the cascade of cellular events in fracture healing.

Evidence for Effectiveness

The evidence base for bone stimulation is strongest for non-union fractures, where electrical stimulation has been used since the 1970s with well-established efficacy. For LIPUS (ultrasound stimulation), the EXOGEN device has FDA clearance for fresh fractures and non-unions and multiple randomized controlled trials showing accelerated healing in specific fracture types. The 5th metatarsal Jones fracture — one of the most problematic foot fractures — shows particularly strong evidence for bone stimulation efficacy, with studies demonstrating significantly faster radiographic healing and return to activity compared to immobilization alone.

Who Benefits Most

Bone stimulation is most beneficial for established delayed unions (fractures showing insufficient healing progress at 3-4 months), non-unions (fractures with no healing progress at 6+ months), high-risk fractures prone to non-union (Jones fractures, navicular stress fractures), patients with systemic factors impairing healing (diabetes, osteoporosis, smoking, immunosuppressive medications), and as an adjunct to surgical fixation in compromised healing environments.

Practical Considerations

Ultrasound bone stimulators are worn for 20 minutes daily, making them among the most convenient treatment options. PEMF devices are worn for longer periods (3-10 hours daily) but can be used while sitting or sleeping. Both types are lightweight, portable, and have excellent safety profiles. Medicare and most private insurers cover bone stimulation for established non-unions when documentation criteria are met. Treatment duration typically ranges from 3-6 months.

Limitations

Bone stimulation is not a replacement for appropriate fracture immobilization and is most effective as an adjunct to standard fracture management. It does not eliminate the need for surgery in cases with poor fracture alignment, significant bone gap, or infection. Realistic expectations — measured improvement in healing rate rather than miraculous overnight healing — are important for patient satisfaction with this technology.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.