The surgical treatment options for late-stage degenerative joint disease in pedal joints are limited, with the gold standard being arthrodesis. A viable joint-sparing alternative is interpositional arthroplasty. The concept of interpositional arthroplasty in the foot originated with the Keller procedure (1), in which he interposed a portion of the medial capsule into the first metatarsophalangeal joint (MTPJ). Since the inception of interpositional arthroplasty, the procedure has been modified, refined, and applied to other pedal joints including the lesser MTPJs as well as the fourth or fifth tarsometatarsal joint (2,3,4,5,6,7,8,9,10,11,12,13,14,15 and 16). A variety of joint-specific techniques have been described in the literature (2,3,4,5,6,7,8,9,10,11,12,13,14 and 15). Graft types include local capsule, local or free autograft, allograft, and synthetic materials. The benefit of preserved joint motion makes interpositional arthroplasty an attractive alternative for some patients.