The medial crossover toe: a cadaveric dissection

The development of a medial crossover second toe (second toe crossing over the first toe) is not a rare clinical condition. It often occurs in the set ting of hallux valgus, although not exclusively so. The resulting displacem ent of the second toe can cause pain in shoes, with surgical correction bei ng problematic. The pathologic anatomy of this condition has not been fully described. In an effort to better understand it, dissection of a cadaveric specimen with a full crossover toe is presented. The dissection revealed f indings not previously documented. They include medial displacement of the flexor tendons and plantar plate along with deformity of the plate itself. These changes are in addition to contracture of the medial collateral ligam ents and the previously described rupture of the lateral collateral ligamen ts. Both the plantar plate and the collateral ligaments, the two major stat ic soft tissue stabilizers of the lesser MP joint, were found to be signifi cantly involved. Pull on the flexor tendons only accentuated the malalignme nt of the toe. Clinical Significance: The extensive soft tissue changes explain the diffic ulty in achieving a successful long term correction of a full medial crosso ver toe with a soft tissue procedure. With attenuation of the plantar plate and medial displacement of the flexor tendons, there is an imbalance of mu scle forces across the MP joint. This muscle imbalance would not be correct ed by release of the medial collateral ligament, dorsal capsular release or extensor tendon lengthening. Reconstruction of the collateral ligament is at risk for incomplete correction since it is unlikely to resolve deformity in the plate if already present.