Sesamoiditis Not Responding to Corticosteroid Injection, Shockwave Therapy, or Physical Therapy
This protocol is for patients with sesamoiditis in whom an initial course of treatment — corticosteroid injection, radial extracorporeal shockwave therapy, or a structured physical therapy programme — has not produced sufficient pain relief or functional recovery within the expected timeframe.
Prior Treatment Goals Not Met
When First-Line Therapy Has Not Worked
The previous treatment line included ultrasound-guided corticosteroid injection, radial extracorporeal shockwave therapy, or a structured physical therapy programme. This protocol is indicated when those measures failed to achieve:
- Reduction in VAS pain score at the first metatarsophalangeal joint
- Improved FAAM-ADL and FAAM-Sports functional scores
- Resolution of sesamoid pain
- All within a 3-month treatment window
Next-Step Approach
For recalcitrant sesamoiditis after failed initial therapy, emerging biologic injection treatments — administered under imaging guidance — have shown promise. The complete protocol, including the specific biologic option and procedural details, is available via the link below.
Treatment Goals
- Reduction in VAS pain score at the first metatarsophalangeal joint
- Improved FAOS subscale scores across symptoms, pain, daily activities, sports, and quality of life
- Return to prior level of sports activity without sesamoid pain
- Achieved within 3 months
References
DOI: 10.3390/medicina61071215
- Despite limited evidence, emerging biologic therapies (e.g., PRP or CBMA injections) also show promise in recalcitrant cases.
- Callahan et al. (2025) described a single leukocyte-rich platelet-rich plasma (PRP) injection under ultrasound guidance, while Shimozono et al. reported the use of CMBA.
- Shimozono et al. reported a significant reduction in VAS scores from 5.8 (range: 4–8) to 1.5 (range: 0–4) following treatment.
- After treatment, all subscales showed substantial improvement: symptoms increased to 90.8 (±7.5), pain to 83.8 (±17.4), daily activities to 92.8 (±7.3), sports activities to 72.5 (±20.1), quality of life to 64.6 (±22.7), and overall score to 81.4 (±13.4).
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