Novel Approach to a Rare Presentation Painful Os Intermetatarseum & Shockwave Therapy First Expereince & Review

Painful Os Intermetatarseum is a rare yet disabling cause of dorsal foot pain in sporting fraternity, necessitating a definite awareness about it and its management. Approach to the management of established painful os intermetatarseum has been largely conservative. Though shockwave therapy has been promising in the field of sports and orthopaedic medicine, yet there is no scientific underpinnings on its therapeutic use in painful os intermetatarseum.

To critically review literature to establish effective ways of managing painful os intermetatarseum and to report the first experience in the world of use of shockwave therapy as conservative tool in painful os intermetatarseum.

Critical Systematic Review and Case Report

Computer-aided searches were conducted using: PubMed, Medline, SAGE, Cochrane, Ovid and Science Direct. An extensive manual search and cross-referencing from review and original articles published between Jan 1963 and December 2013 were performed. The search strategy combined key words expanding the terms ‘painful os intermetatarseum’ for population, ‘management’ for intervention, and ‘pain, return to activity’ for outcome. Predefined inclusion and exclusion criteria were applied.

Eleven relevant papers were found, including case reports and case series. Current evidence suggests surgery to be preferred option than conservative approach in management of painful os intermetatarseum irrespective of the natural history of the condition. In the current review no paper was found relating to the use of shockwave therapy in painful os intermetatarseum.

Based on the current review it can be concluded that the evidence has been anecdotal and that there is need of large scale randomised trial for a better clinical interpretation and guideline laying for the conservative approach, and in that use of shockwave therapy in conservative management of painful os intermetatarseum needs to be explored.