A Tailor’s Bunion, also known as a Bunionette, is a painful, bony bump that develops on the outside of the foot at the base of the little toe. This prominence causes significant discomfort, especially when wearing shoes that place pressure on the area.
Identifying the Cause of the Bunionette
The physical manifestation of a Bunionette is the enlargement or lateral deviation of the fifth metatarsal head, the long bone connecting to the little toe. The condition is sometimes referred to as a Tailor’s Bunion because tailors traditionally sat cross-legged, placing prolonged pressure on this area of the foot.
While external pressure from footwear is a common aggravator, the underlying structure of the foot often predisposes a person to this condition. Inherited foot mechanics, such as a splayed forefoot or an abnormal configuration of the fifth metatarsal bone, increase the risk. When narrow or pointed-toe shoes compress the forefoot, they push the fifth metatarsal outward, making the inherited structural issue symptomatic.
Immediate Non-Invasive Relief Strategies
Managing the symptoms of a Bunionette begins with reducing pressure and friction on the painful area. The most impactful change involves selecting appropriate footwear. Shoes should feature a wide, deep toe box to provide ample space for the forefoot and prevent the little toe from being compressed. Avoiding high-heeled shoes is also recommended, as they shift body weight forward and increase pressure on the toes.
Protective padding offers instant relief by acting as a buffer between the bony bump and the shoe material. Over-the-counter bunionette pads, made from felt or gel, cushion the prominence and minimize rubbing. This helps reduce localized inflammation and skin irritation. Moleskin can also be applied directly to the skin for a slim barrier against shoe friction.
Applying cold therapy is a reliable method for decreasing acute pain and swelling around the joint. Icing the affected area for 10 to 15 minutes constricts blood vessels, reducing inflammation. This process can be repeated several times a day, especially after periods of activity or prolonged standing.
For temporary pain management, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be taken orally. These medications reduce both pain and the inflammatory response in the joint. Topical NSAIDs, available as creams or gels, offer a localized alternative when applied directly to the area.
Professional and Surgical Treatment Paths
When conservative treatments do not adequately control the pain, professional medical assessment is necessary. A podiatrist or foot specialist can conduct a detailed examination, often including X-rays, to accurately assess the degree of the bone deformity and rule out other conditions.
The specialist may recommend custom orthotics, which are prescription shoe inserts designed for the individual’s specific foot structure. These devices correct abnormal foot mechanics and redistribute pressure away from the fifth metatarsal head, stabilizing the foot. Unlike over-the-counter arch supports, custom orthotics address the biomechanical issues contributing to the Bunionette, preventing further progression.
For severe, localized inflammation resistant to oral anti-inflammatory drugs, a steroid injection may be considered. A corticosteroid is injected directly into the bursa, the small fluid-filled sac overlying the bony prominence, to rapidly reduce swelling and pain. This intervention is typically reserved for acute inflammation rather than serving as a long-term solution for the bony deformity itself.
If the Bunionette causes chronic, disabling pain that interferes with daily life and conservative measures have failed for several months, surgical correction becomes an option. The most common procedure is an osteotomy, which involves cutting the fifth metatarsal bone to realign it and narrow the forefoot. Depending on the severity, the bone cut may be performed at the head, shaft, or base of the metatarsal. In less severe cases, the surgeon may perform a simple exostectomy, which involves shaving off the excess bony prominence without cutting or realigning the bone.