Sympathectomy as a treatment modality for non-healing ulcers and disabling pain of the fingers has been shown to have favorable outcomes. The chronic pain, ulceration and gangrene of the digits seen in scleroderma patients can involve both the upper and lower extremities. The microsurgical technique of dividing the sympathetic nerve branches to digital vessels with adventitial stripping has been extended to the digits of the lower extremity. Patients with non-healing digital ulcers and chronic pain who have failed medical therapy have been offered sympathectomy as a final option prior to amputation. Sympathectomy of the toe is an uncommon and underused treatment option for scleroderma patients and has not yet been described in the literature. We have transposed our experience with sympathectomy of the hand to patients with similar symptoms in the toes. We retrospectively reviewed five patients who underwent toe sympathectomy from 2001-2002. A total of ten toes were involved and each of the five patients had ulceration. All of the patients complained of chronic pain that was not relieved with conventional medical treatment. All of the patients reported complete relief of pain and ulcer healing, with an average follow-up of twenty-four months. None of the patients have required amputation. This is a work in progress as our patient pool is expanding. Further testing to evaluate the degree of operative success is currently underway. Pre- and post-operative plethysmography and cold stress testing will be used to quantitate an improvement in digital arterial pressures. Our previous experience with digital sympathectomy of the hand has proven to be beneficial to select scleroderma patients. Our brief experience with sympathectomy of the toe has yielded similar benefits. We propose toe sympathectomy for patients with symptoms refractory to medical therapy, however further testing to quantify the benefits have yet to be performed.