Background Floating toe deformity is most frequently associated as a complication of a metatarsal oblique shortening osteotomy, seen in 15% to 50% of patients undergoing this procedure. This deformity is due to shortening of the metatarsal head, which alters the center of rotation and changes the vector of the intrinsic flexor tendons. The same deformity occurs in the absence of the metatarsal head. In cases of long-standing deformity, digital amputation remains as a salvage procedure and may be agreeable in older patients. This video presents an alternative surgical technique with metatarsal head allograft transplant with plantar plate repair. Case Presentation Our patient is a 19-year-old woman with pain at the left second toe and floating toe deformity after metatarsal head excision at an outside hospital owing to a bony tumor. She underwent a second procedure, which was unsuccessful in correcting her deformity. Her symptoms included constant aching pain that was refractory to conservative therapy including bonnet splinting, toe taping, and shoe wear modifications. On examination, she had a floating toe deformity of the second toe with crossover to the third toe. Radiographs demonstrated absence of the metatarsal head and dorsiflexion with lateral deviation of the toe through the second metatarsal phalangeal joint. Surgical Technique A longitudinal incision is made down to the extensor digitorum longus and brevis tendons, which were Z-lengthened owing to contracture. We then make an oblique plantar osteotomy after subperiosteal dissection. The allograft—which includes plantar plate, collateral ligaments, and proximal phalanx—is opened at the back table and a matching oblique plantar osteotomy is made while the ligaments and plantar plate are dissected from the proximal phalanx. The plantar plate is prepared with a mattress suture before implantation of the allograft. The allograft is inserted and secured via two 2.0-mm cortical screws. The sutures through the plantar plate are passed through two drill tunnels at the base of the proximal phalanx, and the suture is tied over the dorsal proximal phalanx. In this patient's case, the medial collateral ligament was imbricated owing to the preoperative lateral deviation. Postoperative Care The patient was non-weight-bearing in a short cam boot until 2 weeks after surgery, when she was seen in clinic for wound check and suture removal. At 2 weeks, she was advanced to heel weight-bearing in the cam boot. At 6 weeks, radiographs were obtained that demonstrated improved alignment without recurrence of deformity. Summary There is little guidance in the literature concerning management of chronic floating toe deformity. While restoration of normal anatomy is not always possible, especially in the setting of chronic shortening, the goal of improving alignment and decreasing pain can be achieved with this procedure.