Extracorporeal Shock Wave Therapy for a Neglected Type III Fracture of the Anterior Process of the Calcaneus in a Collegiate Hurdler: A Case Report

BackgroundFractures of the anterior process of the calcaneus (APC) are frequently misdiagnosed as ankle sprains and may progress to symptomatic nonunion. Degan type III APC fractures involve the calcaneocuboid joint and are conventionally managed surgically. Extracorporeal shock wave therapy (ESWT) has not previously been reported for this fracture type.Case presentationA 21-year-old male collegiate hurdler presented with a 2-year history of left lateral foot pain. Computed tomography confirmed a neglected Degan type III APC nonunion. After declining surgery, he underwent 9 sessions of focused ESWT (peak energy flux density 0.07-0.25 mJ/mm²) in 3-session sets over 19 weeks, combined with a 3-month sports restriction from the start of treatment. Pain resolved completely (visual analog scale 75/100 → 0/100), and he returned to competitive hurdling at 6 months after starting ESWT. Computed tomography at 14 months after ESWT initiation confirmed bony bridging.ConclusionExtracorporeal shock wave therapy was associated with clinical improvement and radiological healing in this individual case and may warrant further investigation as a non-surgical option in young athletes with a neglected Degan type III APC nonunion who decline surgery.