Congenital macrodactyly is a rare congenital malformation characterized by progressive enlargement of all mesenchymal elements of a digit. The most characteristic finding noted was excessive overgrowth of fibrofatty tissue with unusually large fatty lobules fixed by a mesh of dense fibrous tissue. Hypertrophy and tortuosity of the digital nerve, a striking feature in macrodactyly of the hand was notably absent in cases affecting the foot. Most of the cases are reported as isolated anomalies. In macrodactyly of the foot, excessive proliferation and accumulation of adipose tissue was the basic lesion whereas involvement of the nerve is the fundamental lesion in gigantism of the hand. The final pathway of genesis of these anomalies must be either the local deficiency of a growth inhibiting factor or local expression of a basic intrinsic factor leading to excessive growth of all elements of the digit.