The authors present an unusual case of polydactyly of the foot in an otherwise healthy adult male. The modern literature describing polydactyly of the foot is reviewed, as well as a review and critique of various classification schemes for foot polydactyly deformities. The authors applied the classification criteria of Blauth and Olason to an atypical case and to other varied, yet typical, presentations of polydactyly of the foot in adults. Nonsurgical and surgical treatment options are reviewed, and a rational treatment plan is proposed based upon use of the classification scheme. They then apply the management plan for symptomatic polydactyly of the foot to the unusual case, and make recommendations for surgical management of this deformity.