Second MTP Joint Instability: Grading of the Deformity and Description of Surgical Repair of Capsular Insufficiency

A crossover second toe is a commonly seen forefoot problem, usually occurring in women aged > 50 years, and often in association with a bunion deformity. The plantar plate is the principal static stabilizer of the second metatarsophalangeal (MTP) joint. Different authors have proposed classifications to define instability of the second MTP joint, but only describe clinical progression of the deformity. Once a plantar plate tear has developed, conservative treatment can eliminate the symptoms and prevent progression of the deformity but cannot achieve correction or realignment of the deformity. The proposed clinical staging and anatomic grading classification combines clinical findings and anatomic aspects of the plantar plate tears. The surgical treatment described herein reconstructs the anatomic structures that lead to the instability of the second MTP joint. A plantar plate tear repair and lateral soft tissue reefing can restore the normal alignment of the joint with an anatomic repair.