Arthroscopy of the first metatarsophalangeal joint (1 MTP) has gained increasing attention in the last two decades. Despite numerous studies describing the surgical technique, only a few provide clinical or radiological outcome data. This systematic review aimed to analyze studies presenting objectively measurable clinical outcomes of patients who underwent 1 MTP arthroscopy as the primary procedure, categorizing results by indication pathology. Following PRISMA guidelines, PubMed and Cochrane databases were searched for studies reporting outcomes of primary 1 MTP arthroscopy, regardless of underlying pathology. The selected articles were thoroughly assessed to extract data regarding the demographics of included patients, pathology, preoperative and postoperative clinical and radiological outcomes, complications, and reinterventions. Fourteen articles, involving 405 patients (419 halluces), were included. Common indications were hallux valgus and hallux rigidus. Notably, Hallux Valgus Angle improved from 28.9° to 12.7°, and Intermetatarsal Angle improved from 13.8° to 9.2°, where reported. In hallux rigidus patients, range of motion increased from 25.15° to 71.3° post-surgery. Temporary or permanent sensory loss occurred in 3% of treated halluces, with 4.28% requiring reoperation. Evidence on 1 MTP arthroscopy as the primary procedure is limited. It is most effective for hallux rigidus, while in hallux valgus cases, it can achieve satisfactory angular corrections but has a relatively high recurrence and reoperation rate. Although this technique is generally safe, further research should compare it with traditional surgical approaches to provide comprehensive insights. IV •Evidence on 1 MTP arthroscopy as the primary procedure is limited•Common indications are hallux valgus and hallux rigidus•Good results have been achieved for hallux rigidus•Angular corrections in hallux valgus yield satisfactory results•A relatively high recurrence and reoperation rates were observed in hallux valgus