Double-stem Swanson silastic arthroplasty was performed without grommets on the first metatarsophalangeal joints of 45 patients (62 feet). After a mean follow-up of 7 years 3 months (range, 5 years 1 month–9 years 10 months), 91% had been helped greatly with survivorship analysis revealing 94.4% implant survival at 10 years and significant improvements in scores for pain, ambulation, function and shoe wear (P < 0.0001). The mean hallux valgus angle decreased from 37.9° to 24.1° (P < 0.0001). This operation provides high levels of patient satisfaction and has distinct advantages over resection arthroplasty or arthrodesis for lower demand patients with arthritis. There was no correlation between the implant's radiological appearance and the latest clinical outcome.