29/10/2025
Psoriasis is not just a skin condition. As a seronegative arthropathy, it can affect the joints and tendons too. This can lead to hallux valgus (bunions), although the exact mechanism is unclear.
Psoriasis can cause an inflammation of the lining of the joints (a synovitis), leading to joint swelling, pain, damage and deformity. A bunion may be a consequence. As the bunion increases in size, pain on the inside of the foot occurs due to the increase in foot width. The inflamed joint may also be painful due to an arthritic process.
Keyhole surgery for bunion and lesser toe corrections, plays a role in helping with these symptoms in psoriasis. The x-rays in the second carousel image show before, 6 weeks after and 6 months after keyhole bunion surgery in a female patient with psoriatic arthropathy (affecting the joints). At 6 months, you can see the bone remodelling following the bunion correction, with a well corrected foot.
Thankfully, with modern treatment for psoriasis and rheumatoid arthritis, I rarely need to perform surgery in this group of patients.