The second MTP plantar plate is the most commonly injured plantar plate in the forefoot, producing the cross-over toe deformity from attenuation. Repetitive hyperextension stress from a long second metatarsal or tight toe box footwear produces the gradual plantar plate attritional failure that allows the second toe to progressively dorsiflex and deviate medially over the hallux.
| Origin | Plantar base of the proximal phalanx of the second toe |
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| Insertion | Plantar aspect of the second metatarsal neck |
| Actions | Prevents hyperextension of the second MTP joint; primary static restraint against dorsal subluxation |
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Plantar plate pathology is tested by the drawer test — dorsal translation of the proximal phalanx base relative to the metatarsal head. Positive drawer (>50% translation) confirms plantar plate insufficiency. MRI shows T2 signal at the plantar plate attachment. Surgical plantar plate repair accessed through a Weil osteotomy (shortening the metatarsal) provides direct repair access and joint decompression simultaneously.
Plantar plate insufficiency producing cross-over toe deformity managed with Weil osteotomy and direct plantar plate repair.
