The lesser MTP joints (2-5) are the final propulsion joints of the foot, accepting 200-800% body weight during terminal stance and push-off. The plantar plate is the primary stabiliser against dorsal subluxation. Lesser MTP joint instability from plantar plate attenuation produces the cross-over toe deformity (second toe crossing over the hallux) and hammer toe progression. Synovitis from inflammatory arthritis targets these joints early.
Second MTP joint instability and cross-over toe from plantar plate attenuation is the most common lesser MTP pathology requiring surgery. Plantar plate repair via dorsal approach with Weil osteotomy provides joint access and distal metatarsal decompression. Freiberg disease (avascular necrosis of the second or third metatarsal head) presents as juvenile MTP joint pain with metatarsal head flattening on radiograph.
Second MTP plantar plate insufficiency producing second toe dorsomedial deviation managed with plantar plate repair and Weil osteotomy.
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