The plantar plate is a thick fibrochondrous structure on the plantar aspect of each metatarsophalangeal joint, attached firmly to the base of the proximal phalanx distally and loosely to the metatarsal neck proximally via the joint capsule. It provides a firm articular surface for the metatarsal head, resists MTP dorsiflexion, and anchors the plantar intrinsic muscles and the plantar aponeurosis slips.
Stabilises the MTP joint against hyperextension (plantar plate failure allows toe dorsal subluxation), provides a loadbearing fibrocartilaginous surface, and anchors the intrinsic tendon insertions.
Plantar plate tears at the second MTP joint are the underlying pathology in chronic second MTP synovitis, second toe crossover deformity (second toe crossing over the hallux), and plantar forefoot pain in middle-aged women. The tear typically occurs at the distal insertion on the proximal phalanx. MRI or ultrasound demonstrates the tear; the modified Lachman test (dorsally stressing the proximal phalanx) demonstrates instability. Direct surgical repair through a dorsal approach with small bone anchors restores MTP joint stability before fixed deformity develops.
Plantar plate disruption at the second MTP allows the proximal phalanx to dorsally sublux and drift medially, producing the crossover toe deformity with the second toe crossing over the hallux; direct plantar plate repair through a dorsal approach with anchor fixation to the proximal phalanx base combined with flexor-to-extensor tendon transfer corrects the deformity.
