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Foot Ankle Clin. 2014 Sep;19(3):385-405. doi: 10.1016/j.fcl.2014.06.013. Epub 2014 Jul 10.

Etiology and management of lesser toe metatarsophalangeal joint instability.

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Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, 960 East Third Street, Suite 100, Chattanooga, TN 37403, USA.
Saint Alphonsus Coughlin Foot and Ankle Clinic, 1075 North Curtis Road, #300, Boise, ID 83706, USA; Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94143, USA. Electronic address:
Weil Foot & Ankle Institute, Des Plaines, IL 60016, USA.
Department of Orthopedics and Traumatology, UNIFESP - Federal University of Sao Paulo, Sao Paulo, Brazil.


The terms crossover toe and lesser metatarsophalangeal joint instability both describe a deterioration of the soft tissue structures that give stability to the lesser MTP joints. Initial treatment regimens focused on indirect repair of the instability without addressing the primary pathology. A staging system of the clinical examination and a grading system of the surgical findings are now available to help surgeons classify and treat the plantar plate insufficiency. Improved imaging techniques and direct surgical repair techniques through a dorsal approach have changed the treatment and possibly the results of this difficult condition.


Crossover toe; Drawer test; Lesser MTP joint instability; Plantar plate

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