Purpose: We assess the mid to long term follow up results of arthrodesis of the first metatarso-phalangeal (MTP) joint and resection arthroplasty of the lesser toes in rheumatoid arthritic forefoot deformity. Materials and Methods: Between 1998 to 2001 year, 25 cases (18 patients) rheumatoid forefoot deformities were surgically corrected. Follow up period was 83 months (range, 63 to 90 months). The clinical outcome was evaluated using subjective satisfaction and AOFAS score. The radiological measurements were hallux valgus angle, first and second intermetatarsal angle, second metatarso-phalangeal angle (MTP-$2^{nd}$ angle). Results: Subjective satisfaction was 76%. AOFAS score improved from 37 to 73. The hallux valgus angle improved from preoperative $39^{circ}$ ($27{sim}64^{circ}$) to $14^{circ}$ ($4{sim}34$) at the last follow up. The intermetatarsal angle were preoperative $13^{circ}$ ($6{sim}22^{circ}$) to $11^{circ}$ ($3{sim}13^{circ}$) at the last follow up, The MTP-$2^{nd}$ angle were preoperative $24^{circ}$ ($9{sim}47$) to last follow up $15^{circ}$ ($2{sim}39^{circ}$) respectively (p>0.05). Complication was intractable callus 10 cases, Interphalangeal arthritis 5 cases. Conclusion: Mid to long term outcomes rheumatoid forefoot reconstruction by first MTP arthrodesis and resection arthroplasty of lesser toes results a satisfaction and pain relief.