Metatarsophalangeal joint (MTPJ) arthritis is characterised by a painful stiff toe. The incidence increases with age, and with an increasing life expectancy it is important that the foot and ankle surgeon is equipped with assessing, investigating and offering an appropriate treatment to their patients. To ensure the surgical procedures are done to a high level we have focused upon the key principles, techniques to ensure these principles are followed and ways and means of dealing with complications should they arise.