End-stage arthritis of the first metatarsophalangeal joint (MTPJ) typically results in anexophytic process with marked limitation of motion. Pain may occur from the degenerative process itself and/or the bone spur formation that may become directly inflamed from shoe gear. The best surgical treatment for end-stage arthrosis of the big toe joint continues to be a controversial topic despite hallux rigidus being recognized clinically for more than 100 years. Although joint-sparing procedures are considered, arthrodesis is recommended, as this procedure is definitive and produces predictable results.