The incidence of an acute, isolated, first metatarsophalangeal (MTP) lateral collateral ligament (LCL) injury is exceedingly rare, with no estimates of the prevalence or incidence of such injury currently described in the literature. Consequently, optimal evidence-based management strategies are uncertain. Ligamentous injuries to the first MTP joint typically occur with traumatic MTP dislocation. The LCL is affected if the dislocation involves forceful hyperextension or abduction of the great toe. An incompetent LCL complex that cannot resist varus force makes the hallux susceptible to chronic varus instability, recurrent subluxation, and pain. Nonsurgical management consists of immobilization, taping, bracing, and physical therapy. Surgical management for first MTP instability includes arthrodesis, plantar plate repair, collateral ligament repair, and collateral ligament reconstruction with the use of an allograft or autograft. Arthrodesis is a reliable treatment option for the management of severe instability or pain; however, arthrodesis is a joint-sacrificing procedure and may not be ideal for young individuals or athletes because motion at the first MTP joint is essential for push-off power for running and jumping. Evidence-based surgical strategies to reconstruct the LCL complex of first MTP joint are limited. This video describes the case presentation of a young, female gymnast with first MTP LCL insufficiency and varus laxity. The patient underwent first MTP LCL repair, which resulted in satisfactory midterm and long-term outcomes.