Planning for distraction includes radiographic templating after the distraction device is in place. Image shows projected placement of bone shelf in addition to space required for wrist reconstruction. A construct of at least 40 mm is required for adequate joint reconstruction. Distraction is continued at a rate of 0.5 mm a day until a 1 cm space is seen between the distal unlar physis and the visible radiocarpal bones. Following adequate distraction metatarsal phalangeal joint transfer is performed.