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Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy
  1. Dawn Thompson1,
  2. Nikos Malliaropoulos2,3,
  3. Nat Padhiar2,3
  1. 1Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
  2. 2European Sports Care, London, UK
  3. 3Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary, University of London, London, UK
  1. Correspondence to Dr Nat Padhiar, nat.padhiar{at}


Sesamoid osteonecrosis is a disabling condition resulting in severe forefoot pain, for which there are limited treatment options. We present a 52-year-old man with 1-year history of pain, aggravated by walking and playing tennis. On examination, pain was localised to plantar aspect of the first metatarsophalangeal joint. Imaging revealed evolving end-stage avascular necrosis of lateral sesamoid with early secondary degenerative changes. Previous exhaustive conservative treatment had been unsuccessful in alleviating his pain. As an alternative to surgery, radial extracorporeal shock wave therapy (rESWT) was proposed. Treatment protocol was 2000 pulses at frequency of 5 Hz, and pressure was varied from 1.2 to 1.8 bar according to patient tolerance. A total of eight sessions were delivered. At completion of treatment, the patient reported minimal discomfort to no pain and was able to return to playing tennis with no recurrence. We propose rESWT to be an effective novel conservative treatment for sesamoid osteonecrosis.

  • Orthopaedics
  • Sports and exercise medicine

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  • Contributors All authors made a significant contribution to the writing of the submitted paper and approved the final version. DT was responsible for literature review and write-up of the case report in question, including preparing the report for submission. Both NM and NP were involved in patient investigation, diagnosis and treatment. They provided the patient images and assisted in writing up the case report. In addition, NM provided important patient information and case history. NP assisted in literature review and description of the more technical aspects of the report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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