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

BACKGROUND: 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. PURPOSE: To evaluate return to athletic activity, return to preoperative performance, and postoperative complications following partial or complete hallux sesamoidectomy in athletically active individuals. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: 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. RESULTS: 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%. CONCLUSION: 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. REGISTRATION: CRD420251170096 (PROSPERO).