Plantar Plate Instability

Abstract

The understanding of lesser metatarsophalangeal joint (MTP) instability has evolved over the years with a better understanding of the pathoanatomy and greater attention to the soft tissue derangement. Historically, lesser MTP pathology was often managed by addressing the osseous pathology alone, with oversight regarding the soft tissue stabilizing structures. The plantar plate is a fibrocartilaginous structure which is a dorsal restraint to the MTP. Deformity occurs when the plantar plate is torn or attenuated. Crossover toe and MTP instability often occur with multiplanar deformity, most commonly with dorsal contracture of the second toe and medial drift over the hallux. Although plantar plate instability can occur secondary to acute injury, the aim of this chapter is to describe cases where by chronic attenuation causes metatarsalgia and digital deformities and elaborate on preoperative work-up and surgical correction.