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Bunionette

Bunionette Deformity (Tailor's Bunion)

Definition

A Bunionette Deformity, also known as a Tailor's Bunion, is a painful prominence or bony bump on the outside of the foot, at the base of the little (fifth) toe. This bump forms at the head of the fifth metatarsal bone where it connects to the toe (the fifth metatarsophalangeal, or MTP, joint).

The prominence is often due to an underlying anatomical issue, such as an enlarged fifth metatarsal head, an increased angle between the fourth and fifth metatarsal bones, or a lateral bowing of the metatarsal shaft. Friction and pressure from narrow or ill-fitting shoes against this bony area cause irritation, inflammation of the overlying soft tissue (bursa), and pain.

Treatment

The goal of treatment is to relieve pain and reduce inflammation. Treatment typically starts with conservative, non-surgical methods.

A. Non-Surgical Treatment:

  • Shoe Modification: This is the most crucial step. Patients should wear shoes with a wide and deep toe box and avoid narrow, pointed, or high-heeled shoes that compress the forefoot.

  • Padding: Over-the-counter or custom bunionette pads can cushion the area and protect it from shoe friction.

  • Orthotic Devices: Custom or off-the-shelf shoe inserts may help address underlying biomechanical issues (like excessive pronation) and reduce pressure on the joint.

  • Medication: Nonsteroidal Anti-inflammatory Drugs (NSAIDs), like ibuprofen, can help manage pain and inflammation.

  • Icing: Applying ice packs to the area can reduce swelling and pain.

  • Corticosteroid Injections: Injections can be used to treat severe inflammation (bursitis) around the joint, though they do not correct the underlying bony deformity.

B. Surgical Treatment: Surgery is considered when non-surgical treatments fail to provide adequate pain relief and the deformity significantly impairs function or quality of life. The specific surgical procedure depends on the type and severity of the deformity:

  • Bunionectomy/Exostectomy: Simple removal of the bony prominence (the bump). This is often reserved for milder deformities (Type 1, enlarged metatarsal head).

  • Osteotomy: Cutting and realigning the metatarsal bone to correct the abnormal angle or bowing. The bone is then stabilized with pins, screws, or plates. This is common for more severe deformities (Type 2 and 3).