[1] The name Toe is taken from its original name Estatoe, pronounced 'S - ta - toe', a native American name associated with the Estatoe trade route leading down from the NC mountains through Brevard where there is a historical plaque with information that affirms the route, on into South Carolina where a village of the same name was located.

[citation needed] The stream headwaters originate in the ravine between the eastern side of the Black Mountains and the Blue Ridge Parkway near the Eastern Continental Divide[2] at 35°42′39″N 82°15′01″W / 35.71083°N 82.25028°W / 35.71083; -82.25028.

[1] At the confluence the far bank (northeast) of the North Toe lies within Mitchell County and the community of Kona lies on the east bank of the North Toe less than one-half mile to the northwest.

[5] The river is also home to a population of the Appalachian elktoe, an endangered species of freshwater mussel.

This article related to a river in North Carolina is a stub.