Pediatric first ray deformities may present in many ways similar to those effecting adults. However, these patients are not adults. Management of the patient and the deformity necessitates special consideration of timing, the patient’s general health, techniques, and perhaps goals. Any simple broad brush approach to the care of these patients will certainly result in both undertreatment and overtreatment. The proper care of these patients is an ongoing process of appropriate management tailored to the patient’s needs, deformities, and developmental age. Proper adherence to these recommendations can improve the patient’s quality of life.