For the past 15 years, a procedure the authors have termed proximal metatarsal segmental resection has been used for the treatment of intractable, painful, submetatarsal plantar keratoses which have failed nonoperative treatments. This simple procedure basically is the resection of a cylindrical segment of proximal metatarsal bone approximately 0.5 cm long. Fifty-four patients (70 metatarsals) underwent the procedure and were followed a mean of 6 years. Good to excellent results were reported in 89% of these patients. Transfer lesions occurred in 18% of feet and were responsible for all fair and poor results. When the procedure was carried out in association with a bunion correction, transfer lesions occurred in 23%; whereas when performed as an isolated metatarsal procedure, transfer lesions followed in 12%. Recurrent keratoses developed in 7%. This technically simple procedure is associated with minimal patient morbidity and should be considered an option in the surgical management of metatarsalgia.