Introduction

Crossover and claw toe deformity has traditionally been a very difficult condition to manage surgically, with high recurrence rates. Multiple methods have been used to treat this condition. Plantar plate “repair” has recently been advocated, with sutures used to repair an assumed tear. Based on clinical experience and anatomical studies (Deland et al. 1995), we believe the main pathology is a distal migration of the plantar plate complex resulting in exposure of the metatarsal to the thin posterior synovial attachment of the plate. The downward forces on the metatarsal head results in herniation of the head inferiorly. Accordingly we have developed a technique using full cuff release of the plantar plate complex that includes complete release of the collateral ligaments, repositioning the plantar plate anatomically and reinforcing the hernial defect with a synthetic mesh graft.