There are many conditions ranging from the benign to the malignant, which can present with enlargement of one or more digits. An understanding of the differential diagnosis is important such that the potentially serious aetiologies are not missed and patients can therefore be treated appropriately. We present two patients, a male and a female aged 58 and 49 respectively, who presented to orthopaedic surgeons with gross enlargement of the toes. There were significant delays to presentation in both cases. Histological and microbiological analysis revealed that chronic, untreated infection was the most likely cause in both cases. Both patients were successfully treated by amputation of the offending digits. Congenital, infective, inflammatory and neoplastic conditions may all cause enlargement of a digit. The cause should be thoroughly sought prior to deciding upon management. Amputation can be successful, enables definitive tissue diagnosis and allows quick return to normal activities. The correct level must be identified pre-operatively.