Twenty-nine patients were operated on for painful conditions of the first metatarso-phalangeal joint using Swanson's implant arthroplasty. In three cases the implant had to be removed. An analysis was made of the remaining 26 cases 4 to 6 years postoperatively based on a clinical and radiographic review. The results were deemed favourable and comparable to those attained by successful resections or osteotomies. The relatively high incidence of reactive bone changes, plus implant breakage in five cases, makes long-term results more uncertain.