Extracorporeal Shockwave Therapy With Extracorporeal Magnetotransduction Therapy for Osteonecrosis of the Metatarsal Head: A Case Series.

Metatarsal head osteonecrosis, also known as Freiberg's disease, is a painful and debilitating condition that is difficult to treat both nonoperatively and operatively. In this report, we present 2 cases of Freiberg's disease in a 49-year-old man and 32-year-old woman who were treated using a combination of focused extracorporeal shockwave therapy (F-SWT) with extracorporeal magnetotransduction therapy (EMTT). Extracorporeal shockwave therapy generates high-energy sound waves hypothesized to stimulate tissue healing through multiple pathways including angiogenesis, immunomodulation, and local cellular proliferation and differentiation. Extracorporeal magnetotransduction therapy, while still a very novel technology is understood to generate high-intensity electromagnetic fields, potentially altering cellular signaling to stimulate healing. Following a series of F-SWT and EMTT, these patients had both significant improvement of symptoms and radiologic improvement. They were able to return to activities following treatment. This report highlights that F-SWT and EMTT may be a nonoperative treatment option for metatarsal head osteonecrosis.