You, the great toe of this assembly?

We report a case of unilateral pre-axial polydactyly of metatarsal type which was incompletely managed. Our patient was a 5-year-old boy with a primary first ray (M1) which was distally short and not making the metatarsophalangeal joint. In addition, there was a proximally hypoplastic lateral accessory ray forming the metatarsophalangeal joint. There was some involvement of the first tarsometatarsal joint. Clinically, there was no leg-length discrepancy or any evidence of anterolateral tibial bowing. The management involved reconstruction of the first ray by fusing the primary M1 with the accessory metatarsal. Furthermore, a subsequent lengthening SCARF osteotomy with bone grafting was also used to normalize the contour of the growing foot. The importance of knowledge of epiphyseal anatomy of the foot in planning the surgical management of such cases cannot be over-emphasized.