We report a case of a 14-year-old male sprinter with bilateral fatigue fractures of the proximal phalanges in the great toes. The patient and his guardian wished for an early return to sports; therefore, focused extracorporeal shockwave therapy (FSW) was administered instead of the traditional surgical treatment for bilateral cases. Four weeks after starting treatment, tenderness had disappeared, and he was able to return to sports. Computed tomography at 24 weeks after starting FSW revealed bone healing, and there was no recurrence of the fatigue fractures at the 48-week follow-up. The lesson learned from this case is that FSW offers a novel, less invasive treatment option for athletes with bilateral fatigue fractures of the proximal phalanges in the great toes who wish for an early return to sports without surgery. FSW has analgesic effects and promotes bone healing, resulting in optimal treatment outcomes. FSW should be considered a standard treatment option for this type of fracture. J. Med. Invest. 72 : 207-210, February, 2025