[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-42692-en":3,"doc-seo-42692-105":30,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":22,"language":23,"language_code":24,"site_id":25,"html_lang":24,"table_of_contents":26,"faqs":27,"seo_title":13,"seo_description":14,"update_tm":28,"read_time":29},42692,2336464648746,"Skyler","https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c",7,"Healthcare","Metatarsophalangeal Joint Instability: Anatomy and Physiopathology","Metatarsophalangeal (MTP) joint instability is a key cause of metatarsalgia and can present as crossover toe deformity, often starting subtly with pain at the base of the proximal phalanx and MTP swelling before progressing to toe deviation. Plantar plate tears play a central role because the plantar plate is a crucial quadrilateral ligamentous stabilizer that restrains tensile load and cushions the MTP joint during weight bearing. The plantar plate’s anatomy, collagen composition, static and dynamic stabilizing relationships, and vascular supply inform surgical decision-making and repair technique selection.","Metatarsophalangeal Joint Instability  \nAnatomy and Physiopathology  \nAyooluwa Segilade Ayoola, MD, James R. Jastifer, MD *  \nKEYWORDS  \n􀀁 Metatarsalgia 􀀁 Plantar plate 􀀁 Metatarsophalangeal joint 􀀁 Crossover toe  \nKEY POINTS  \n􀀁 Plantar plate tears are a cause of metatarsalgia.  \n􀀁 The plantar plate is a crucial metatarsophalangeal (MTP) joint stabilizer.  \n􀀁 The biomechanics of the MTP joint determines the crossover toe deformity in the presence of a plantar plate tear.  \nINTRODUCTION  \nMetatarsalgia is commonly seen in the clinical practice of foot and ankle surgeons. A common cause of metatarsalgia is metatarsophalangeal (MTP) joint instability; however, there are other causes of MTP pain (Box 1) .1–3 Severe MTP joint instability often presents as a “second crossover toe.” Coughlin first described this term in 1987 .4 Coughlin characterized the deformity of the second toe extending at the MTP joint and overlapping the great toe medially. It is important to note that the toes do not begin to crossover until later in the disease process. The patient may present, initially, with pain at the base of the proximal phalanx and MTP joint swelling; this could evolve to deviations at the MTP joint, often subtle at first. Crossover toe can affect all the lesser toes, not just the second toe, but is commonly seen in the second toe.1 ,5–9 The factors that result in MTP joint instability are not completely understood. However, it is most likely multifactorial. Most recently, studies have noted an association between plantar plate tears and MTP instability.10 Although clinical and surgical grading systems have been developed to assess plantar plate injury and define the disease process’s severity, an understanding of the anatomy and pathophysiology is important.9 , 11–13  \nDepartment of Orthopaedic Surgery, Homer Stryker M.D. School of Medicine, Western Michigan University, 1000 Oakland Avenue, Kalamazoo, MI 49001, USA  \n* Corresponding author.  \nE-mail address: [jrjast@gmail.com](jrjast@gmail.com)  \nFoot Ankle Clin N Am 29 (2024) 681–690  \n[https://doi.org/10.1016/j.fcl.2023.12.006](https://doi.org/10.1016/j.fcl.2023.12.006) [foot.theclinics.com](foot.theclinics.com)  \n[1083-7515/24/](1083-7515/24/)ª 2023 Elsevier Inc. All rights reserved.  \n682 Ayoola & Jastifer  \n\n| Box 1\u003Cbr>Differential diagnosis of metatarsalgia |\n| --- |\n| Lesser toe instability MTP joint synovitis MTP joint arthritis Metatarsal stress fracture Synovial cyst Interdigital neuralgia Freiberg infarction |\n\nANATOMY OF THE PLANTAR PLATE  \nThe plantar plate is a quadrilateral ligamentous structure that originates proximal to the articular surface of the plantar aspect of the metatarsal head as a thin, weak synovial structure and inserts into the base of the proximal phalanx as a robust attachment (Fig. 1) .2 , 14 , 15 The plantar plate cradles the metatarsal head. It is fibrocartilaginous and on average 19 mm long and about 2 mm thick.16 , 17 It is made of 75% type 1 collagen, with little elastin. Its fibers run longitudinally with some interwoven oblique fibers.16 , 17 Its high type 1 collagen content could be a factor in the poor healing capacity noted. The plantar plate acts as the primary restraint against tensile load in the sagittal plane and acts as a cushion during weight-bearing in the MTP joint.3 ,7 Its central and plantar location makes it an essential stabilizer of the MTP joint.3 , 18 , 19 The plantar plate also acts in concert with the other structures that attach to it. This includes the distal fibers of the plantar fascia, the collateral ligaments, the transverse metatarsal ligaments, the interosseous tendons, and the fibrous sheath of the flexor tendons. The collateral ligaments and the plantar plate act as static stabilizers, whereas the intrinsic muscles act as dynamic stabilizers.7 , 18 The collateral ligaments are made of two major structures: the proper collateral ligament (PCL) and the accessory collateral ligament (ACL) . The PCL inserts into the ","cbCairKKMXM3zsQS","https://ap.wps.com/l/cbCairKKMXM3zsQS","pdf",858623,2,1,10,"English","en",105,"# Key Points\n# Introduction\n# Anatomy of the Plantar Plate\n## Structure and stabilizing role\n## Collateral ligaments and dynamic stabilization\n## Vascular supply and surgical implications","[{\"question\":\"How does plantar plate tearing contribute to metatarsalgia?\",\"answer\":\"Plantar plate tears are identified as a cause of metatarsalgia. Because the plantar plate is the main stabilizer of the MTP joint, damage can disrupt joint mechanics and lead to forefoot pain.\"},{\"question\":\"What is the relationship between MTP instability and crossover toe deformity?\",\"answer\":\"MTP joint biomechanics determine crossover toe deformity when a plantar plate tear is present. Severe instability can manifest as a “second crossover toe,” where the second toe extends at the MTP joint and overlaps the great toe medially.\"},{\"question\":\"What anatomical features of the plantar plate are important for stability and healing?\",\"answer\":\"The plantar plate is a fibrocartilaginous, quadrilateral structure that cradles the metatarsal head and provides key restraint against tensile load in the sagittal plane. Its high type 1 collagen content is noted as a possible factor for poor healing capacity.\"}]",1783356871,25,{"code":4,"msg":31,"data":32},"ok",{"site_id":25,"language":24,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"metatarsophalangeal-joint-instability-anatomy-and-physiopathology","",{"@graph":36,"@context":85},[37,53,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,47,50],{"item":41,"name":42,"@type":43,"position":21},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":20},"https://docshare.wps.com/document/","Document",{"item":48,"name":12,"@type":43,"position":49},"https://docshare.wps.com/document/healthcare/",3,{"item":51,"name":13,"@type":43,"position":52},"https://docshare.wps.com/document/metatarsophalangeal-joint-instability-anatomy-and-physiopathology/42692/",4,{"url":51,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":24,"description":14,"dateModified":61,"datePublished":62,"encodingFormat":60,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":41,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-07-13","2026-07-06",true,{"@type":65,"interactionType":66,"userInteractionCount":20},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"How does plantar plate tearing contribute to metatarsalgia?","Question",{"text":75,"@type":76},"Plantar plate tears are identified as a cause of metatarsalgia. Because the plantar plate is the main stabilizer of the MTP joint, damage can disrupt joint mechanics and lead to forefoot pain.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"What is the relationship between MTP instability and crossover toe deformity?",{"text":80,"@type":76},"MTP joint biomechanics determine crossover toe deformity when a plantar plate tear is present. Severe instability can manifest as a “second crossover toe,” where the second toe extends at the MTP joint and overlaps the great toe medially.",{"name":82,"@type":73,"acceptedAnswer":83},"What anatomical features of the plantar plate are important for stability and healing?",{"text":84,"@type":76},"The plantar plate is a fibrocartilaginous, quadrilateral structure that cradles the metatarsal head and provides key restraint against tensile load in the sagittal plane. Its high type 1 collagen content is noted as a possible factor for poor healing capacity.","https://schema.org",{"og:url":51,"og:type":87,"og:title":13,"og:site_name":58,"og:description":14},"article",{"robots":89,"canonical":51},"index,follow",{"doc_id":7,"site_id":25},{"code":4,"msg":5,"data":92},[93,97,101,105,110,115,118,123,128,131,134],{"id":21,"doc_module":4,"doc_module_name":46,"category_name":94,"show_sort_weight":95,"slug":96},"Story & Novel",90,"story-novel",{"id":20,"doc_module":4,"doc_module_name":46,"category_name":98,"show_sort_weight":99,"slug":100},"Literature",80,"literature",{"id":52,"doc_module":4,"doc_module_name":46,"category_name":102,"show_sort_weight":103,"slug":104},"Exam",70,"exam",{"id":106,"doc_module":4,"doc_module_name":46,"category_name":107,"show_sort_weight":108,"slug":109},5,"Comic",60,"comic",{"id":111,"doc_module":4,"doc_module_name":46,"category_name":112,"show_sort_weight":113,"slug":114},6,"Technology",50,"technology",{"id":11,"doc_module":4,"doc_module_name":46,"category_name":12,"show_sort_weight":116,"slug":117},40,"healthcare",{"id":119,"doc_module":4,"doc_module_name":46,"category_name":120,"show_sort_weight":121,"slug":122},8,"Research & Report",30,"research-report",{"id":124,"doc_module":4,"doc_module_name":46,"category_name":125,"show_sort_weight":126,"slug":127},9,"Religion & Spirituality",20,"religion-spirituality",{"id":126,"doc_module":4,"doc_module_name":46,"category_name":129,"show_sort_weight":126,"slug":130},"World Cup","world-cup",{"id":22,"doc_module":4,"doc_module_name":46,"category_name":132,"show_sort_weight":22,"slug":133},"Lifestyle","lifestyle",{"id":135,"doc_module":4,"doc_module_name":46,"category_name":136,"show_sort_weight":106,"slug":137},19,"General","general"]