A review of 159 feet with double-stem silicone implants in the hallux metatarsophalangeal (MTP) joint was conducted in two medical centers. The majority of patients had a diagnosis of rheumatoid arthritis. Follow-up evaluations ranging between 18 months and six years indicate that pain relief was present in all cases with most having complete relief of pain. Hallux valgus was corrected in most and a functional range of motion as well as good muscle strength was restored. The stability provided by the procedure has improved the postoperative alignment of the lateral MTP joints from which the metatarsal heads had been excised. Operative technique must be precise and tissues must be handled and prepared for the implant with care.