The objective of this retrospective study was to analyze the long-term clinical outcomes and patient satisfaction of operative care in patients with symptomatic hallux rigidus. Seventy-seven patients (94 feet) underwent cheilectomy, Keller resection arthroplasty, or arthrodesis between 1990 and 2000. All were invited to return for follow-up evaluation after a minimum of 2 years (mean, 7 years). The average patient age was 53 years (range, 22-77 years). Outcomes were assessed by questioning and examining the patients and by evaluating radiographs according to the Regnauld's classification system. Overall patient satisfaction was good; average visual analogue and American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scores were 1.8 and 81, respectively. Eighty-seven percent stated they would undergo the same procedure again. After cheilectomy, the average visual analogue score was 1.4 for grade I and 2.3 for grade II, and rating scale scores were 87 and 82, respectively. There were comparable results for the Keller resection arthroplasty where visual analogue scores were 0.4 and 1.6, respectively, while AOFAS scores were 94 and 83, respectively. Average visual analogue scores and AOFAS scores in grade III patients after a Keller procedure and an arthrodesis were 2.3; 87 and 2.0; and 73, respectively. In the arthrodesis group, 4 patients required revision because of complications. Cheilectomy is a good choice for patients with grade I and II hallux rigidus because it is a safe and simple joint-preserving procedure. For end-stage hallux rigidus without preexistent metatarsalgia, the Keller procedure was favored over arthrodesis of the first metatarsophalangeal joint.