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.

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