A bunionette, also known as a Tailor’s Bunion, is a painful bump that develops on the outside edge of the foot at the base of the little toe. This bony protrusion occurs at the head of the fifth metatarsal bone, which connects the pinky toe to the midfoot. The deformity often causes irritation, inflammation, and discomfort, especially when wearing footwear. This guide explores solutions for managing this condition, from at-home care to definitive surgical procedures.
Defining Bunionettes and Identifying the Cause
A bunionette is an enlargement or prominence of the fifth metatarsal head on the foot’s lateral side, often accompanied by the little toe deviating inward toward the fourth toe. This condition is primarily attributed to a combination of inherited foot structure and external mechanical pressure. Some people naturally inherit a foot structure that makes them prone to the deformity.
The primary external cause involves wearing narrow or pointed shoes that crowd the toes and compress the forefoot. High-heeled shoes can exacerbate the problem by forcing the foot forward and increasing pressure on the toes. Over time, this constant friction and pressure irritates the joint, leading to the bony enlargement. The historical name, “Tailor’s Bunion,” comes from tailors sitting cross-legged, which put constant pressure on the outer edges of their feet.
Immediate Non-Surgical Relief
Initial treatment focuses on reducing pain and inflammation while slowing the deformity’s progression. Selecting shoes with a wide toe box and a low heel eliminates pressure on the painful area. Footwear should be supportive and allow the toes to spread naturally without compression.
Padding and cushioning can provide immediate relief by acting as a barrier between the bunionette and the shoe. Applying soft gel pads or moleskin directly over the bony prominence helps to minimize friction and irritation. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to manage pain and reduce localized swelling.
Applying ice for 15 to 20 minutes helps decrease inflammation and numb the pain, particularly after prolonged activity. Devices like toe separators or night splints can temporarily maintain better toe alignment, reducing joint stress. Specific stretching and strengthening exercises, such as toe scrunches, improve flexibility and strengthen surrounding muscles, aiding in alignment and easing tension.
Surgical Procedures for Correction
Surgical intervention is reserved for cases where conservative measures have failed, and the bunionette causes severe pain or significantly impairs the ability to wear shoes and perform daily activities. The procedure aims to mechanically correct the underlying bone deformity. Two main categories of procedures are used depending on the severity and specific cause.
One approach is an exostectomy, which involves shaving off the prominent bony bump from the side of the metatarsal head. This procedure is only suitable for very mild cases where toe alignment is not severely shifted. Since an exostectomy does not correct the underlying structural misalignment, it is often combined with a more comprehensive procedure to prevent recurrence.
The more common and definitive method is an osteotomy, which involves making small, precise cuts in the fifth metatarsal bone. The surgeon then repositions the bone fragments to realign the joint and correct the outward bowing, securing the new position with small screws or pins. This realignment procedure addresses the mechanical cause of the bunionette.
Recovery time varies, but most bunionette surgeries are done on an outpatient basis. Initial healing, requiring a surgical boot or cast and limited weight bearing, typically takes six to eight weeks. A full return to normal activity and a wider range of footwear usually occurs within three to six months as the bone mends and swelling subsides.
Preventing Recurrence
After successful treatment, long-term habits are necessary to prevent the bunionette from returning. The most important preventive measure is the permanent avoidance of narrow, pointed, or high-heeled shoes that compress the forefoot. Consistent use of footwear with a wide, deep toe box keeps pressure off the lateral aspect of the foot.
If prescribed, wearing custom-made orthotics is effective for long-term maintenance. These devices correct subtle biomechanical imbalances, ensuring proper weight distribution and alignment. Maintaining a healthy body weight and regularly performing foot-strengthening exercises also reduce excessive stress on the metatarsal joints. These adjustments help stabilize the foot’s structure and minimize the risk of recurrence.