Return to Athletic Activity Following Sesamoidectomy: A Systematic Review of Time Frames and Clinical Outcomes

Hallux sesamoid pathology can cause persistent forefoot pain and loss of push-off strength in athletically active individuals, and sesamoidectomy is commonly performed when prolonged nonoperative management fails.

To evaluate return to athletic activity, return to preoperative performance, and postoperative complications following partial or complete hallux sesamoidectomy in athletically active individuals.

Systematic review; Level of evidence, 4.

PubMed, Embase, and CENTRAL were searched through October 2025 for studies reporting outcomes in athletically active individuals undergoing sesamoidectomy. Data extraction included demographics, pathology, operative details, follow-up duration, return-to-sport metrics, return to preoperative performance, and complications.

Six studies met inclusion criteria, representing 193 patients. Female patients comprised 72.2% of reported cases. The weighted mean return-to-sport rate was 91.9%. The weighted mean time to return to sport was 12.2 weeks. Return to preoperative performance occurred in 83.6% of patients. Complication rates ranged from 0% to 29.2%, with a weighted mean complication rate of 12.5%.

Sesamoidectomy allows most athletically active individuals to return to athletic activity within 3 to 4 months postoperatively, although approximately 16% fail to return to their preoperative level of performance. Postoperative complications occurred in 12.5% of patients and should be considered during preoperative counseling. These findings may help guide shared decision-making for patients considering sesamoidectomy after failed conservative treatment.

CRD420251170096 (PROSPERO).