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Message: <blockquote data-quote="Caliban" data-source="post: 1724192" data-attributes="member: 284">Based on a few shows I've seen regarding real life people with this disability,  I would say the main effect would that you can't often wear boots or shoes, or wield a weapon. Why can't you wear boots?  Because most likely you would have learned to use your toes/feat as rudimentary hands.   You would be able to perform most day to day activities without to much trouble (after a lifetime of practice), but would have real problems with the extreme types of activities that adventurers are usually involved in.  Most manual tasks would have a -2 penalty if they dont' require fine manipulation, or a -6 (or greater) if they do require fine manipulation.   Certain activities are most likely impossible.  (Climbing a rope, many craft skills, etc.) Other skills might have a bonus (such as Balance, because you have learned to stand on one foot while using the other to manipulate things).  Wielding most weapons would be impossible, but you might be able to make do with armor spikes.  Spellcasting would be difficult. Somatic gestures would probably be impossible (you would either have to prepare all spells with the Still feat, or learn alternate versions that substitue toe/foot wiggles for finger/hand gestures (maybe with a +0 level metamagic feat).  Psion or Monk would seem like your best bet for and adventuring class.</blockquote>