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The purpose of this study is to present a surgical treatment option following iatrogenic shortened first ray pathology and report the postoperative outcomes. Retrospective analysis of two surgeon’s patients (N=5) who underwent gradual distraction osteogenesis following previously failed first ray surgery was conducted.  Surgical outcomes were measured including time in the external fixator and amount of distraction achieved. Complications measured included neurovascular complications, non-union, mal-union, infections, mal-alignment, pain, wound dehiscence, stiffness and transfer metatarsalgia. The average time spent in an external fixator was 78.8 (34-108) days. Average distraction achieved was 12.2 (2-22) mm. Four of the 5 patients experienced at least one of the following postoperative complications: pin site infections, wound dehiscence, non-union and postoperative pain. This study suggests that distraction osteogenesis may be a feasible surgical treatment option for iatrogenic shortened first ray with the right patient selection, but needs further evaluation.