Introduction: Various prostheses can be selected for the arthroplasty for adult patients with destruction of or missing joints in upper limb. These procedures, however, are not suitable for children because of their limited durability and interference with growth. We use an autologous toe joint transfers to reconstruct the congenitally missing or stiff joints in children. Patients: Fourteen joints of 12 patients were reconstructed using toe joint transfers. Reconstructed joints consisted of 4 PIP joints with true symphalangism, 1 elbow joint of a patient with Crouzon's disease and 7 carpometacarpal (CMC) joints of 7 hypoplastic thumbs (4 type III-B and 3 type IV). One MP and one CMC joint of thumb were reconstructed as the salvage procedure for the inappropriate previous surgeries for congenital problems. Age at operation ranged from 1 year and 4 months to 16 years and 9 months old with an average of 5 years and 8 months. Procedure: We used the PIP joint of the second toe for finger PIP symphalangism, the second metatarso-phalageal (MTP) joint for 7 hypoplastic thumbs and the first MTP joint for an elbow joint. Either PIP or MTP joint was elevated on the long vascular system of the first dorsal metatarsal or plantar artery. Multiple tendon transfers were combined for adduction, abduction, extension and flexion of the reconstructing thumb for the reconstruction of hypoplastic thumb as well as the elevation of the dorsalis pedis skin for the coverage of the bulky MTP joint. An external fixator was applied for the stabilization of the transferred first MTP joint for elbow reconstruction. The average follow-up was 11.6 years for Blauth type III-B, 13 months for Blauth type IV reconstruction, 11 years for salvage cases and 2.3 years for the elbow reconstruction. RESULTS: All transfers were successfully performed and mobile painless joints were reconstructed. The epiphyses have kept open as those in other toes allowing expected growth. Active range of motion (AROM) from 40°to 102°was attained for the reconstructed PIP joint of true symphalangism. Total AROM of IP and MP joint averaged 36°for Blauth type III-B hypoplastic thumb. AROM for the reconstructed elbow was 55°allowing sucking of thumb that was not demonstrable before surgery. Discussion: Mobile and painless joints can be reconstructed for the congenitally defective or stiff joint to attain useful hand function by the autologous toe joint transfer. We believe these procedures can be one of the most useful joint reconstructions for children.