Great toe and second toe transfers have gone from being a niche microsurgical procedure to the gold standard in reconstructive surgery for thumb and finger loss, providing functional and aesthetic restoration that surpass traditional methods. Here we discuss the history of toe transfers, advances in microsurgical techniques, clinical anatomy and refined dissection strategies. Recent validated functional outcome measures using the Michigan Hand Questionnaire have demonstrated their superiority to equivalent digit replantation, particularly for thumb and multidigit amputations. Concerns about donor site foot morbidity appear to be unfounded, with validated Foot Function Index scores better than normative population values. Data therefore support the wider use of toe transfers to reduce global disability after digit amputation.