Lesser metatarsophalangeal (MTP) joints instability is usually produced by the rupture of the plantar plate. The treatment algorithm may change in patients with advanced stages of the plantar plate rupture, and surgical treatment is proposed to avoid MTP dislocation. Palliative surgery with minimally invasive surgery (MIS) can offer a less aggressive approach and enable excellent clinical correction and a good function. The authors proposed an algorithm for MIS treatment of MTP instability based on a combination of different osseous and/or soft tissues surgical procedures that the authors will combine differently depending on the evolution degree.