Aim: To assess long-term outcome of Silastic Joint Replacement of the þrst metatarsophalangeal joint. Methods: 32 patients (42 feet) with double stem silicone implant arthroplasty of the 1st MTPJ were reviewed at average 8 years (range 4 Ð 19 years). Surgery was for Hallux rigidus in 25 cases and for Hallux valgus with degenerative osteoarthritis in 17 cases. Patients with Rheumatoid arthritis were excluded. Mean patient age was 64 years. Results: 28 of the 32 patients were very satisþed with the procedure. No patients were dissatisþed. Pain relief was subjectively excellent or good in 28 patients. Three of the four patients with fair or poor relief of pain had surgery for Hallux Valgus with degenerative osteoarthritis. Radiographs showed sclerosis around all prostheses with cysts with bony erosions in 17 cases. 12 had clinical features of silicone synovitis in the early postoperative period but this was not present at þnal review despite radiological þndings of new bone formation (57%) and localised osteolysis (40%). Two patients had transfer metatarsalgia with a stress fracture. No patients required revision surgery. Conclusion: Our long-term study shows patients to have very good subjective and objective results despite poor radiological results. There is a role for double stemmed silicone implant arthroplasty in low demand patients.