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J Foot Ankle Surg. 2016 Nov - Dec;55(6):1333-1335. doi: 10.1053/j.jfas.2016.07.024. Epub 2016 Sep 8.

Radial Soundwave for Sesamoidopathy in Athletes: A Pilot Study.

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Director, Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA. Electronic address:
Care Provider, Kaiser Permanente Hawaii, Oahu, HI.
Foot Care Specialist, Central Jersey Ankle and Foot Care Specialists, Aberdeen, NJ.
Professor, Department of Orthopedics, University Schleswig-Holstein, Kiel, Germany.
Professor, Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.


The purpose of the present study was to evaluate the efficacy of radial soundwave therapy (RSW) for the management of sesamoiditis, symptomatic bipartite sesamoids, and avascular necrosis in athletic patients. The data from 10 patients undergoing RSW for sesamoiditis were retrospectively studied. Three treatments at 2.4 Bar and 13 Hz, for a total of 2500 pulses in each session, were administered to the affected sesamoid approximately 1 week apart. The Roles and Maudsley score and the visual analog scale (VAS) were used to assess disability and pain. An overall improvement was seen in reported pain after RSW. The pretreatment VAS score was 5.9 ± 1.7 and the post-treatment VAS score improved to 2.3 ± 2.4 (p = .0001). The activity pretreatment Roles and Maudsley score was 3.1 ± 0.3 and the post-treatment score was 1.5 ± 0.7 (p = .00003). All but 1 of the patients (90%) reported some or complete relief of pain. The mean time to return to activity was 10.1 ± 15.6 weeks, although this value was biased by 1 patient requiring 1 year to return to activity. Eliminating this patient, the average time to return to activity was 5.4 ± 5.6 weeks. Three patients in the cohort did not have to stop their desired activity at all, including 1 gymnast and 1 runner. Of these 3 patients, 2 (20% of all patients) reported complete relief of pain (VAS score of 0) after treatment. The third patient experienced a significant decrease in pain, with the VAS score, improving from 7 to 1. The results of the present study have demonstrated that RSW can be a viable treatment of certain symptomatic sesamoid pathologies and can be considered a valid alternative to surgery.


avascular necrosis; bipartite sesamoid; sesamoidectomy; sesamoiditis

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