Lesser Metatarsophalangeal Joint Instability: Arthroscopic Treatment Alternatives

Instability of the lesser toes metatarsophalangeal (MTP) joints is a common forefoot problem and can present as metatarsalgia, synovitis, and lesser toe deformities. The plantar plate contributes to MTP joint stability through its interaction with the plantar aponeurosis, and plantar plate insufficiency is the primary cause of MTP joint instability. Conservative treatment options, including the use of nonsteroidal anti-inflammatory medications, intra-articular steroid injections, orthosis, and accommodative shoe modifications, generally provide only temporary relief and do not effectively halt the progression of deformity in most cases. In this article, the different arthroscopic treatment alternatives are discussed including plantar plate tenodesis.