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Forefoot surgical outcomes were evaluated in 26 patients with rheumatoid arthritis. A total of 45 procedures were reviewed with emphasis on first ray intervention. Disease duration and aggressiveness of preceding medical therapy were combined to establish a disease severity index. Patients operated were predominantly in the midrange of disease severity. Subjective data on the relief of pain, callus, and deformity were favorable but this benefit was not long lasting inasmuch as patients were most satisfied in the period immediately following surgery and less so as time elapsed from intervention. Fusion of the first metatarsophalangeal joint seemed better than resection alone, indicating that stability should be the primary goal for surgical intervention of the rheumatoid forefoot.