There is a paucity of objective information in the literature about first metatarsophalangeal (MTP) hemiarthroplasty. The authors postulate that it is a reasonable treatment option for severe hallux rigidus in selected patients. Twenty-two elective first MTP hemiarthroplasties were performed on 20 patients that met the inclusion criteria. Pre- and postoperative evaluations were done using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) pain score, range of motion (ROM) measurements, and radiographs. Average ROM and dorsiflexion improved by 15° and 8°, respectively. VAS pain scores improved from 5 to 2.5 after six weeks. Painless ambulation occurred after six weeks, with maximum improvement by six months. After 24 months, two patients had pain at the surgical site interfering with function, leading to an unsatisfactory result that required conversion to arthrodesis. First MTP hemiarthroplasty for severe hallux rigidus can be considered an alternative to fusion in properly selected patients who wish to maintain a functional range of motion.