Metatarsophalangeal Joint Pathologies and Surgical Interventions

The metatarsophalangeal (MTP) joints are critical for normal gait and weight distribution across the forefoot. Common pathologies include degenerative and inflammatory arthritis, hallux valgus, lesser-toe instability, Freiberg’s disease and plantar plate tears. Pain, deformity and impaired function often arise from capsuloligamentous attenuation, sesamoid displacement or fibrocartilaginous rupture beneath the metatarsal heads. Conservative measures such as orthotics, activity modification and image-guided injections can provide symptom relief, but refractory cases frequently require surgery. Surgical options range from joint-preserving osteotomies—Weil, chevron or scarf—to joint-sacrificing arthrodesis, implant arthroplasty and reconstruction of the plantar plate or collateral ligaments. Minimally invasive and arthroscopic techniques have expanded indications for early-stage instability, while tendon transfers and tenodesis procedures offer dynamic realignment of flexible deformities. Advances in high-resolution imaging and intra-operative guidance enhance diagnostic precision and surgical planning, ensuring restoration of forefoot biomechanics and reduction of recurrence rates.

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Metatarsophalangeal Joint Pathologies and Surgical Interventions publication trend

The graph below shows the total number of articles in metatarsophalangeal joint pathologies and surgical interventions across all publications each year (not limited to Nature Index journals).

Technical terms

Plantar plate: A fibrocartilaginous structure beneath the metatarsal heads that stabilises the MTP joint and resists dorsal subluxation of the proximal phalanx.

MTP subluxation: Partial displacement of the proximal phalanx relative to the metatarsal head, often due to plantar plate attenuation or ligamentous injury.

MRI “stress test”: An additional magnetic resonance imaging sequence performed with joint hyperextension to accentuate plantar plate tears and joint instability.

Weil osteotomy: A distal metatarsal neck osteotomy that shortens and realigns the metatarsal to relieve pressure under the MTP joint.

Flexor tenodesis: A surgical technique that anchors flexor tendons to bone to dynamically correct flexible toe deformities and restore MTP joint alignment.

Arthroscopic radiofrequency shrinkage: A minimally invasive method using thermal energy to tighten capsuloligamentous structures in cases of early MTP instability.

References

1. MRI in the evaluation of plantar plate disease: diagnostic value of the “stress test”. Journal of Orthopaedics and Traumatology (2024).
2. Degenerative injuries of the metatarsophalangeal plantar plate on magnetic resonance imaging: a new perspective. Einstein (São Paulo) (2022).
3. Flexor tenodesis procedure in the treatment of lesser toe deformities. Archives of Orthopaedic and Trauma Surgery (2021).