Background: Stress fractures occur to the musculoskeletal system on a frequent basis. This injury in the foot and ankle is relatively benign and treated conservatively with a walking boot or postoperative shoe. The use of an injectable bone graft has shown success with bone marrow edema and osteoarthritis in the knee, thus the same effects would be seen worthy of stress fractures relating to other parts of the body such as the foot and ankle. The foot and ankle sustains a high level of stress and is prone to stress fractures. This retrospective analysis documents several cases of stress fractures treated with an injectable allograft.

Methodology/Procedures: A retrospective analysis was conducted on twenty-eight individuals, ages 20-75, who underwent bone repair with an injectable calcium phosphate graft by one of the study investigators. Diagnosis was made with MRI imaging studies prior to surgical intervention. Intraoperatively, fluoroscopy was used to identify the surgical site to be injected. After appropriate targeted position of a cannula, the graft was injected into the site of injury. Retrospective analysis was performed by chart review and phone contact to each participant with a minimum follow-up of twelve months post-procedure. A prewritten questionnaire was used to acquire patient and procedure feedback after verbal consent was obtained.

Results: A total of twenty-seven patients were evaluated. Thirteen underwent injection of bone graft for calcaneal stress fractures, six for talus stress fractures, three for metatarsal fractures, and one for a fibula fracture. One individual presented with both a calcaneus and a talus stress fracture, one with a cuboid and a metatarsal fracture and two patients with both metatarsal and cuneiform fractures. Of those represented in this trial, 24 out of the 27 patients felt no pain and were back to their normal lifestyle and routines four weeks post-procedure. At their 12-month follow-up questionnaire conducted verbally, patients continued to report no pain and actively had resumed their lifestyles.

Discussion: The analysis showed that 80% of participants had a minimum of 75% relief twelve-months post-procedure. Only 3/25 patients reported a level 5 or higher on a pain scale of 10, after the use of this treatment. Most participants returned to lifestyle activities quickly and were pain-free after a short postoperative period of treating their bone marrow lesion.

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License. It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © The International Foot & Ankle Foundation for Education and Research (internationalfootankle.org), 2022

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