Seventy-five feet in 47 patients (46 women, 1 man) who had rheumatoid arthritis were observed for an average of 6 years (range, 4-11 years) after an operation on the forefoot that included a shortening oblique osteotomy of the metatarsal neck of the lateral toes. In addition, patients underwent either flexible hinge toe implant arthroplasty or Mitchell's osteotomy in the first metatarsophalangeal joint. Forty-two feet (56%) looked normal with no valgus or dorsal displacement of the toes. Recurrence of callosities occurred in 9 feet (12%) with moderate pain in 3 feet. Thirty-nine (83%) patients were satisfied with the outcome after surgery. Resection arthroplasty often is recommended for management of forefoot deformities. However, as shown in this series, the improvement in deformities, function, and cosmesis of metatarsophalangeal joint preservation may be better with an osteotomy of the metatarsal neck than with a resection arthroplasty. Because of the development of combined drug therapy, the benefits of synovectomy, osteotomy, and shortening in length should be reconsidered. The authors' studies suggest that the shortening oblique osteotomy should be considered 1 of the surgical reconstruction options for patients with rheumatoid arthritis who have forefoot deformities.