In order to acquire the mutated toe, the Chosen One must spend a certain amount of time in toxic waste without protection, causing the mutation to occur. The toe can then be amputated and acquired as an item in a medical center equipped with an Auto-Doc.
- Having a mutated, unremoved toe will result in failure of the Vault City citizenship test.
- Some non-player characters claim the toe is a one-hit K.O. device for destroying Frank Horrigan, but that is only a joke, although it does lower his max HP by 3 points.
- In a rather humorous note, the game responds with "You just ate your fucking toe!" if it is consumed.
- The lump of brain in the Fallout 3 add-on Point Lookout makes a direct reference with "you feel a terrible sense of loss." The cure research note in The Pitt also makes reference to the item.
Behind the scenes