Metatarsophangeal joint instability of the lesser toes

Instability of the lesser metatarsophalangeal (MTP) joint occurs with deterioration of the plantar plate and/or collateral ligaments leading to pain and deformity. Previously described, treatment techniques have utilized an indirect repair of the instability (soft tissue balancing and periarticular osteotomies) without addressing the plantar plate deficiency. We describe a staging system of the clinical examination, and a grading system of the surgical findings which is helpful to clinicians to both classify and also treat the primary pathologic findings. An improvement in imaging techniques and the use of direct surgical repair techniques have changed the treatment and possibly the results of this troublesome condition.