Introduction describes first metatarsophalangeal (MTP) joint arthrodesis as a historical and currently powerful option for severe forefoot deformities, including arthritis, hallux valgus, hallux varus, and trauma. Shortening of the first ray, particularly after MIS bunion procedures and revisional surgeries, creates biomechanics challenges that can compromise fusion. To address large segmental defects, the senior author advocates interpositional femoral head allograft to restore first-ray length and provide structural support for stable MTP joint arthrodesis. The approach avoids autograft drawbacks, and emphasizes accurate debridement and graft sizing, vascular assessment, and biotechnologic enhancement to promote osteogenesis, with fusion outcomes supported by retrospective data.