Return to sport following stress fractures of the great toe sesamoids: A systematic review

Abstract

Introduction This review aims to provide information on return rates and times to sport following stress fractures of the great toe sesamoids (SFGTSs). Sources of data A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Scopus, SPORTDiscus and Web of Science was performed using the keywords stress', fractures', great', toe', sesamoid', athletes', sports', non-operative', conservative', operative' and return to sport'. Areas of agreement Fourteen studies were included: Three studies reported on the outcome of conservatively-managed SFGTSs; thirteen studies reported on the outcome of surgically-managed SFGTSs. The management principles were to attempt conservative management for 2-6 months using activity modification, analgesia, orthotics and physiotherapy; if symptoms persisted following this, surgical management was to be recommended, either with internal fixation or sesamoidectomy. Areas of controversy The optimal treatment modalities for SFGTSs remain to be defined. Growing points Internal fixation shows the best return to full-level sport rates with low rates of complications. Areas timely for developing research Future prospective studies should aim to establish the optimal treatment modalities for SFGTSs.