A tailor’s bunion, also known as a bunionette, is a painful enlargement of the joint at the base of the little toe (the head of the fifth metatarsal bone). This bony prominence creates a bump on the outside of the foot, causing redness, swelling, and discomfort when rubbing against footwear. The condition is named after the historical practice of tailors sitting cross-legged, which put constant pressure on this area. While genetics or foot structure often influence the condition, symptoms are frequently aggravated by wearing narrow or tight shoes.
Conservative Home Management
Managing a tailor’s bunion begins with simple changes focused on relieving pressure and friction. The most impactful modification involves switching to shoes that feature a wide toe box and soft upper materials. Avoiding footwear with pointed toes or high heels is important, as these styles compress the forefoot and increase irritation of the fifth metatarsal head.
Protective padding provides a physical barrier against shoe pressure, reducing friction and localized pain. Products like felt, moleskin, or silicone gel sleeves can be applied directly over the bony bump for relief. Taping the little toe may also be used to gently pull it into a more neutral position, reducing the deviation that causes the prominence to rub against the shoe.
For acute pain and swelling, applying an ice pack for 15 to 20 minutes several times a day minimizes inflammation. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken orally to manage discomfort and temporarily reduce swelling. These strategies alleviate symptoms and prevent the bunionette from worsening due to external aggravation.
Medically Supervised Non-Surgical Options
When home care is insufficient, a healthcare specialist, such as a podiatrist, may recommend targeted non-surgical treatments. Custom orthotics, distinct from generic over-the-counter arch supports, address the underlying biomechanical issues of the foot. These prescription inserts redistribute pressure away from the prominent fifth metatarsal head and stabilize the foot’s structure, slowing the progression of the deformity.
Physical therapy is an effective intervention, focusing on exercises that improve the foot’s intrinsic muscle strength, flexibility, and gait mechanics. Specific routines, like toe curls or pinky toe abduction exercises, improve the alignment and function of the foot. This approach helps correct imbalances that contribute to abnormal pressure distribution on the outside of the foot.
If inflammation is severe and localized, a corticosteroid injection may be administered directly into the affected joint or surrounding soft tissues. This potent medication provides substantial, though often temporary, relief from pain and swelling. Injections are reserved for episodes of acute flare-ups and are not a long-term solution for the underlying structural deformity.
Surgical Procedures for Severe Cases
Surgery is considered the last option for a tailor’s bunion, reserved for instances where severe pain persists after six to twelve months of conservative treatment. The goal of surgery is to realign the fifth metatarsal bone and eliminate the painful bony prominence. The choice of technique depends on the severity of the deformity, determined through clinical examination and X-ray imaging.
One common technique is an exostectomy, which involves shaving off the enlarged portion of bone on the side of the metatarsal head. This is used for milder deformities where the main issue is a bony spur. For more significant misalignment of the fifth metatarsal, an osteotomy is performed, which requires cutting and repositioning the bone.
During an osteotomy, the surgeon makes a precise cut in the metatarsal bone and uses small screws or wires to hold the bone in corrected alignment while it heals. Following surgery, patients require a post-operative recovery period, often involving a specialized surgical shoe. Full recovery can take several months, and rehabilitation with physical therapy is recommended to restore strength and mobility.