Few reports in the literature have described the use of an osteochondral allograft for the treatment of articular cartilage damage of the 1st metatarsal phalangeal joint. We present here the clinical outcomes and detailed surgical technique of four cases in which we used a cryopreserved, viable, osteochondral allograft (CVOCA) for full cartilage replacement of the first metatarsal head to address degenerative articular cartilage damage. At 10-22 months of follow-up, patients reported clinical improvement, with VAS pain-scale scores decreasing from an average of 8.0 to 0 post-operatively, and range-of-motion improvement from an average of 4.3 degrees to 58.3 degrees dorsiflexion. Radiographic improvement was also seen, with an increase in average joint space from 1.1mm, 1.5mm, and 2.2mm from medial to lateral on dorsoplantar views pre-operatively, to 3.1mm, 2.8mm, and 3.1mm 15 months post-operatively, respectively. These results suggest that CVOCA is a desirable treatment option for end-stage degenerative joint disease of the first metatarsal phalangeal joint.