Exogen Bone Stimulator: Dramatic Help for my Patients

     If you read my blog you know I love the Exogen bone stimulator since it strengthens bone. I have hundreds of patients benefit with healing at a faster pace then expected, or healing when no improvement was expected. It is not a cure all. But when you want to try to give a bone injury a chance to heal, especially in my sesamoid injury patients, Exogen is my go to Bone Stimulator. Most sesamoid injuries are within the bone and there is not definite fracture line or gap. The goal is to get bone stronger, which is all I care about, and symptom relief seems to follow. 

https://fda.report/GUDID/M937710344001

Exogen and Sesamoid Healing

Dr. Blake - I was a patient of yours back in 2016 when I broke my sesamoid bone in my left foot. You were AMAZING and helped me figure out that a) I didn't need to be wearing that large 1/2 leg boot and b) I could bike with my little boot. This was the inflection point in my healing process (and happiness).

The other part of my healing was the EXOGEN bone healing system that I purchased with the prescription you made for me.

My wife now has a fracture in one of her metatarsals. I suggested she use the EXOGEN machine that I still have, but unfortunately, the battery ran out. When we contacted the manufacturer, they said that we need to have an active prescription.

Do you think you could help us with this? She is happy to come see you and get a second diagnosis if that would help. Unfortunately, her doctor at Kaiser didn't think that the EXOGEN was important. I feel that it helped me a lot, so I wanted to see if I could help set Joanna up it as well.

I hope all is well on your end,

Dr. Blake's comment: 
     I am so happy you have done well. Yes, the Exogen will strengthen the bone well. Unfortunately, I would need to see her and have an active record. Sorry because this is an expense for Kaiser patients. Tell the doc at Kaiser what is the big deal for him to write an RX. Kaiser does not have to pay. Have they checked Vit D deficiency or Bone Density? Need to know the overall health of the bone to see if it will heal. Rich

Bone Stimulators for Fracture Healing: Common Questions

Hi Dr. Blake,

I heard from the rep about the bone stimulator.  He said my part of the cost would be $500.  I think you said that, but I thought that was what they charged the insurance company.  So, I’m a little sticker shocked.

I called him back to find out what kind it was, so I could do a little research to see if they really work.  He got kind of defensive, and warned me not to buy a used one online.  He is a salesperson, not a caregiver.  He said it is an ultrasound device made by Exogen.

My googling revealed that there are not great studies, but some people got good results.  The devices are for one person to use and then toss.  They are programmed to die after a given number of uses.  The wholesale cost is $1500, they ask $4000, and my insurance company pays $2500.  There are certain things about our medical system that I find disturbing, and this is one of them.

That said, I trust you and I am grateful for your care.  If you recommend it, I’ll go for it. My PT said I should ask you what % bone healing I currently have.

Since the rep gave me the idea, I looked up the Exogen on Craigslist, and they go for $60 - $250 (used).  Is this an option?

Thanks

This patient has fractures in the first metatarsal and first cuneiform bones with a major amount of bone demineralization from resting the area in removable boots. Most of his pain may be coming from some arthritis in the first metatarsal cuneiform joint, and not from a healing fracture! Too difficult to tell right now. 

Dr Blake's response: 

     Thanks for doing some research on bone stim. The bone stim is a 9 month experiment. You are healing, but still have more pain then I would like. People do stop healing, or the pain can be from the arthritis and nothing to do with the bone fx. It is all educated guesses. I think the chance of the stimulator helping  you is 20%, but if we don't do it, it could come back to bite us. And, if it does work, we won't know really if it was the bone stim! Such is life, but I would still have you pay the money for the stim, then an elaborate holiday gift to your favorite podiatrist!!LOL. Rich

Exogen Bone Healing System recommended by Dr Blake

http://www.exogen.com/non-union/

     Over the last 10 years, Exogen has been the only bone stimulation system I have used. I am very pleased by the results. I have no financial connection with this company. My patients use 20 minutes once a day for 6 to 9 months. It has almost eliminated surgery for some injuries like sesamoid fractures. 

Exogen Bone Stimulator: For All Stages of Bone Fracture Healing

This is the bone stimulator I primarily use with patients. Many insurance companies will only cover if the fracture healing is delayed (past 3 months). But, since it works from day one of a fracture, some hard to heal fractures like Jones Fractures of the 5th metatarsal, any metatarsal fracture that has broken through both sides, sesamoid fractures, navicular fractures, calcaneal fractures, and talar neck fractures would be greatly helped with the bone stimulator if it could be started early. I am hopeful insurance companies will see the logic in this.

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.

Respectfully,

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.

http://www.drblakeshealingsole.com/2014/10/painful-2nd-mpj-email-advice.html

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.

http://www.drblakeshealingsole.com/2014/04/arch-taping-with-kinesiotape-kt.html

I hope this helps you. Rich