The vascularized toe joint transfer is an alternative to arthrodesis. For optimal functional results, the patient must have normal-functioning muscle and associated tendons, effecting joint motion. Although vascularized toe joint transfer permits long-term preservation of joint architecture and cartilage, the goal of achieving normal range of motion for a reconstructed digit is still elusive. Reconstruction of the extensor mechanism can be worthwhile in selected patients because more useful motion can be achieved even if the result falls short of normal.