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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.

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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

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