Many studies have evaluated bilateral versus unilateral surgery in large joints, however, limited research is available to compare outcomes of bilateral-staged foot surgeries versus synchronous-bilateral foot surgery. 186 consecutive cases of first metatarsophalangeal joint surgery were prospectively included in this study; 252 procedures were performed: 120 were unilateral or staged-bilateral, and 66 were synchronous-bilateral operations. Patients were evaluated at 6–and 12-weeks for specific early complications, and surveyed about there return to work, activities of daily living, shoe gear requirements, satisfaction, and reasons for choosing staged or synchronous surgery. Additionally, a cost analysis was performed on all surgical scenarios. Student-t test showed no statistical significance between groups in all clinical settings to a 95% confidence level. Complication rates were similar and few in all situations. Patients were very satisfied when choosing bilateral-synchronous surgery and would elect to repeat it the same way 97% of the time. The economic costs to the health system average 25% greater when patients undergoing first metatarsophalangeal joint surgery have the procedure performed one foot at a time. Combined with the time lost from work, this reveals a significant economic cost to both society and patient.