Background <p>For thumb reconstruction at the metacarpophalangeal (MCP) joint level, there are currently two toe groups commonly used as reconstructive materials: the second toe (2ndT) flap and flaps harvested from the great toe (great toe, trimmed great toe, and wrap-around great toe flaps). We aimed at comparing the results and donor morbidity after reconstruction of thumb amputation at the MCP joint level between trimmed great toe (TGT) and second toe (2ndT) transfers.</p> Methods <p>The study conducted a retrospective analysis from January 2011 to December 2019. A total of 32 thumb amputations at the MCP joint level on 32 patients were reconstructed by 16 TGT and 16 2ndT transfers. The preoperative data, postoperative hand recovery, and foot morbidity of the two groups were compared.</p> Results <p>There were no statistically significant differences between the two transfer groups with regards to survival rate and the results of postoperative hand recovery (Kapandji score, pinch strength, grip strength, total active motion, static 2 points discrimination, QuickDASH score, Michigan Hand Outcomes Questionnaire score, aesthetics score, and patient satisfaction score). On foot morbidity, there was a statistically significant difference between the standing time with eye closure on the operated foot and the non-operated foot in the TGT transfer group; however, there was not in the 2ndT transfer group.</p> Conclusions <p>Compared with the 2ndT transfer, the TGT transfer has the same results in hand recovery but leads to more impaction on the balance capacity of the donor foot. The decision of the TGT transfer should be limited to patients requiring high balance function of the foot.</p> Level of evidence <p>Level III, therapeutic study.</p>