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

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.