RT Journal Article
SR Electronic
T1 Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2017-219191
DO 10.1136/bcr-2017-219191
VO 2017
A1 Dawn Thompson
A1 Nikos Malliaropoulos
A1 Nat Padhiar
YR 2017
UL http://casereports.bmj.com/content/2017/bcr-2017-219191.abstract
AB 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.