Lesser toe deformities are often more complex than they may appear. The ‘lesser toes’ function is to contact the ground and increase the surface area for load bearing, but a variety of pathologies may conspire to make achieving this apparently simple goal a seemingly impossible task. There is an intricate interplay between intrinsic and extrinsic muscles, the plantar plate, and the shape and function of the rest of the foot to consider when planning surgical management. A sound understanding of the basic anatomy and pathology is the key, and the surgeon should be able to apply a methodical, stepwise approach to the management of the deformities encountered. This chapter aims to set out an overview of the basic anatomy and pathology, and to provide an algorithm which can be used as the basis of the treatment of lesser toe deformities. Some more recent advances in techniques are discussed, although the underlying principles of correction remain, as ever, far more important than any specific method of correction.