The authors feel that capsular interposition arthroplasty can give predictable pain relief in carefully selected individuals with severe (grade III) hallux rigidus. Attention to the relative lengths of the first and second metatarsals, minimal shortening of the proximal phalanx, and use of the dorsal capsule and EHB tendon as an interposition all contribute to good to excellent objective and subjective results. Approximately 30% of patients undergoing this procedure experience some degree of transfer metatarsalgia postoperatively and probably require orthoses for sports. The authors feel that this operation presents a reasonable alternative to many patients who are candidates for an arthrodesis of the first MTP joint for advanced degenerative disease.