Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 May 22:2017:bcr2017219191.
doi: 10.1136/bcr-2017-219191.

Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy

Dawn Thompson  1 , Nikos Malliaropoulos  2   3 , Nat Padhiar  2   3
Affiliations
Case Reports

Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy

Dawn Thompson et al. BMJ Case Rep. .

Abstract

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.

Keywords: Orthopaedics; Sports and exercise medicine.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
High-resolution CT of axial view of the foot.
Figure 2
Figure 2
Short time of relaxation & excitation weighted (T1W) MRI sequence of the axial view of the foot.
Figure 3
Figure 3
Short tau inversion recovery (STIR) MRI sequence of axial view of the foot.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Toussirot E, Jeunet L, Michel F, et al. . Avascular necrosis of the hallucal sesamoids update with reference to two case-reports. Joint Bone Spine 2003;70:307–9. 10.1016/S1297-319X(03)00061-7 - DOI - PubMed
    1. Barral CM, Félix AM, Magalhães LN, et al. . The bone scintigraphy as a complementary exam in the diagnosis of the avascular necrosis of the sesamoid. Rev Bras Ortop 2012;47:241–5. 10.1016/S2255-4971(15)30093-8 - DOI - PMC - PubMed
    1. Moen MH, Rayer S, Schipper M, et al. . Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study. Br J Sports Med 2012;46:253–7. 10.1136/bjsm.2010.081992 - DOI - PubMed
    1. Moretti B, Notarnicola A, Garofalo R, et al. . Shock waves in the treatment of stress fractures. Ultrasound Med Biol 2009;35:1042–9. 10.1016/j.ultrasmedbio.2008.12.002 - DOI - PubMed
    1. Malliaropoulos N, Crate G, Meke M, et al. . Success and recurrence rate after radial extracorporeal shock wave therapy for Plantar fasciopathy: A retrospective study. Biomed Res Int 2016;2016:1–8. 10.1155/2016/9415827 - DOI - PMC - PubMed

Publication types