We have studied the incidence of fractures of the proximal femur in one English county from 1968 to 1991. Numbers have increased steadily, but the age-specific incidence has remained relatively unchanged since 1981. The increase is due to the rise in the population most at risk; this is likely to continue causing a 20% increase in demand for treatment by the year 2000. Suitable allocation of resources must be planned.

1. Arthrodesis of the first metatarso-phalangeal joint combined with excision of those lesser metatarsal heads with fixed subluxation and painful callosities is an excellent treatment for painful hallux valgus with metatarsalgia.

2. A series of thirty feet in twenty-five patients is reported in which this combined operation was done.