Arthrodesis of the first metatarsophalangeal joint is a highly successful treatment for patients with symptomatic hallux rigidus who have failed conservative management. Before arthrodesis, the importance of host factors, such as use of nicotine, local blood supply, medical comorbidites, and use of systemic immunosuppressive agents, must be considered. Arthrodesis is currently considered the gold standard treatment for end-stage arthritis of the metatarsophalangeal joint. Careful attention to surgical detail is critical to achieving optimal outcomes.