Treatment of fixed deformities of the lesser toe proximal interphalangeal and distal interphalangeal joints can be difficult when the wrong procedure or poor patient selection is combined with the unpredictability often encountered with treatment of these deformities. Surgical treatment of these deformities entails not only bony resection for correction but also some degree of soft-tissue balancing and an understanding of the underlying etiology. Treatments are similar for the mallet, hammer and claw toe deformities of the second through fourth toes. The hammer toe or cock-up fifth toe is approached differently and can often be the most challenging. Several techniques have been described for correction of these deformities, but the techniques described here should provide reproducibly good to excellent results.