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Thursday, October 2, 2014

Exogen Bone Stimulator and 4th Metatarsal Fracture: Email Advice

Hi Doctor Blake,

I came across your blog when searching about Exogen Bone Stim machines because I couldn't get a question answered that I had. So since you seemed really passionate about all things foot and ankle, I thought I might email you and see if I could get your opinion about my question. So here goes. I got a Exogen in 2012, for what was diagnosed as a small fracture of the fourth metatarsal head, which was not improving over a significant amount of time (six months or more). My doctor said that it could also have been something called a vascular necrosis, but that seems to have been ruled out since I have improved significantly since using the bone stim machine. So I used the machine for a very long time, possibly a year, but it still has uses left on it. Then last week after trying some things during a workout that might have been premature to try, (after feeling my best in easily five years for maybe the last 4 months) I have been feelings some small symptoms in the exact area that I used the machine on. I wondered IF there was any harm in beginning to use the machine again to possibly encourage more blood flow to that area and continued healing. Any advice you have would be greatly appreciated!
Best Wishes,

Dr Blake's comment: 

     I am not sure if the bone stimulator actually increases blood flow, but I know it definitely causes the little bone forming cells (osteoblasts) to have fun!! So, why not use it in case you have a stress fracture, stress reaction, or cartilage weakness. I see no harm. Good luck!! Rich

Patient's response:

Thank you for the response, I appreciate your time greatly. If you have any time at some point, I just wondered if I could ask you another question since you seem to have so much knowledge in this area. I just wanted to know if you thought it was normal for a fourth metatarsal head fracture (described to me as small by way of mri) to still be having problems-since it wad presumably injured due to "overuse" sometime in 2011 and not treated until summer/Nov of 2012. I ceased almost all activity from nov 12' to may 13', used the bone stim machine for over one year, and continued to progress after may of 2013, and this past summer, (14') thought I had made nearly a full recovery.  Currently I have of course increased the intensity of my training regiment (heavy weight lifting) , which was always the goal-and after two months of success, seem to suddenly have slide backwards a bit. I'm considering seeing my doctor here in Virginia if it doesnt calm down but really want to avoid any kind of surgery. My symptoms are mild soreness, tenderness and also at times the surrounding areas and the metatarsal head are tingling almost like pins and needles. At times when I hold the fourth metatarsal head with my fingers I can definitely feel that it feels different from the rest-almost like it is still mildly inflamed and/or has scar tissue. Any additional insight is so greatly appreciated once again.


Dr Blake's comment:

     Sure, after an injury to the metatarsal, you can be left with some permanent soft tissue changes (internal scar mainly) and some slow to resolve new bone growth (as the metatarsal heals stronger than originally). I am always looking at metatarsal positioning as a possible source of continuing pain. Is the bone lower than normal? Is my link below which discusses 2nd met pain, but can apply to any metatarsal.

Many cases of fourth metatarsal injuries are related to 2 factors:

  1. tendency to be too supinated with overload on the lateral side of the foot
  2. excessive looseness of the 5th metatarsal, so the weight goes onto the 4th met
So, your biomechanics may need to be evaluated and changed or the problem can continue. 

What to do now? 
  1.     Attempt to create a protected weight bearing situation holding the pain between 0-2. 
  2.     Ice 2-3 minutes for 10-15 minutes the bottom of your foot
  3.     With any bone injury, you have to consider your Vit D and Calcium intakes (may take a discussion with your internist.
  4.     I love Kinesiotape circumferential taping for compression, stability, and lowering of the 5th metatarsal. You can also use Rocktape.

I hope this helps you. Rich


  1. What are the differences in the models which have on them "Exogen 4000+" and those that only have "Exogen"

    1. I just know the Exogen 4000 is the newest model. I will try to get some other info. Rich


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.