Fifth metatarsal stress fracture is a failure of a healthy metatarsal bone subject to repetitive microdamages. It has a high prevalence in soccer players and is classified as a high-risk stress fracture. Based on Torg classification, the treatment options may be conservative or surgical. The recent increase of evidences about Shock Wave Treatment in different bone pathologies, including stress fractures, suggests the possibility to use this conservative intervention option also in patients candidate for surgery. This randomized clinical trial included 18 soccer players diagnosed of proximal fifth metatarsal stress fracture, randomly matched in Surgery group and Shock Wave group. Patients of Surgery group were treated with intramedullary screw fixation; patients of Shock Wave group received 3 weekly sessions of Focused Shock Wave Treatment (F-ESWT), using an electrohydraulic device set to an energy flux density (EFD) of 0.21 mJ/mm2 and 2000 impulses. Patients of both groups were followed monthly until their return to play (RTP) using radiography, Visual Analogue Scale (VAS), Tegner Activity Level Scale and AOFAS score.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
A Kirschner wire was introduced in the proximal tuberosity under anteroposterior and lateral fluoroscopic control, following the bone axis and passing through the fracture line; a cannulated compressor screw in a diameter between 45 - 55 mm in the more satisfactory position to achieve the optimal fragments compression.
3 weekly session, one per week, of focused shock waves, using an electrohydraulic device.
Fundacion Garcia Cugat
Barcelona, Spain
Evaluation of X-Ray
X-Ray study
Time frame: Follow up until recovery (maximum of 6 months)
Period until return to play
When the patient can start the previous to injury activity
Time frame: Follow up until recovery (maximum of 6 months)
Evaluation of Visual Analogue Scale
Subjective evaluation of the pain intensity from 0 (non-existent paint) to 10 (maximum pain feeling)
Time frame: Follow up until recovery (maximum of 6 months)
American Orthopedic Foot and Ankle Score
Measures the results of the treatment for complex foot and ankle injuries that combines a patient informed and a specialist informed report. Scores range from 0 to 100, with a healthy midfoot receiving 100 point.
Time frame: Follow up until recovery (maximum of 6 months)
Evaluation of Tegner activity scale
Tegner activity scale grades the daily life activities and recreational and professional sports practice. A score of 0 represents sick leave or disability pension because of knee problems, whereas a score of 10 corresponds to participation in national and international elite competitive sports \>6 score can only be achieved if the person participates in recreational or competitive sport.
Time frame: Follow up until recovery (maximum of 6 months)
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