Arthrodesis of the 1st metatarsophalangeal joint (MTPJ) is a common procedure used for the treatment of end stage arthritis. We studied a cohort of patients who underwent an isolated 1st MTPJ Fusion for the treatment of hallux rigidus. Here we report the 10-year clinical outcomes, complication rate, requirement for further surgery and patient experience. All patients, who underwent an isolated 1st MTPJ Fusion for osteoarthritis from June 2008 until November 2011 were included. Demographics, clinical outcome data and subsequent procedures performed were collected from a departmental database (Bluespier). Patients were contacted and asked to complete the MOxFQ questionnaire and rate their satisfaction using pain, function and if they would undergo the surgery again. Mean follow up was 10.85 (range 9–12) years. A total of 161 patients (183 feet) underwent an isolated 1st MTPJ fusion during this time period. 156 of the feet showed a successful arthrodesis (85.2% fusion rate); 27 patients required revision surgery, 19 (10.4%) for a symptomatic non-union and 8 (4.4%) for mal-union. Those patients with co-morbidities (diabetes and gout) required revision earlier than those without (p<0.01). Average MOxFQ score was 16.6 (0–64) and 28 out of the 38 (73.6%) said they would have the operation again. Overall, the long-term results of the 1st MTPJ fusion had good outcomes with a successful fusion rate and minimal complications, both in line with the corresponding literature. In this series, fusion provided high patient satisfaction with the majority of patients opting to undergo fusion with the gift of hindsight