A tailor’s bunion, also known as a bunionette, is a bony prominence that develops on the outside of the foot. This bump appears at the base of the little toe, specifically at the fifth metatarsophalangeal (MTP) joint, where the pinkie toe connects to the rest of the foot. It is similar to a bunion on the big toe, but on the opposite side. The name “tailor’s bunion” originated from the historical practice of tailors sitting cross-legged, which put consistent pressure on this area.
Anatomical and Biomechanical Contributions
The development of a tailor’s bunion often involves a combination of inherited foot structures and biomechanics. Some individuals may have a genetic predisposition, such as an abnormally splayed fifth metatarsal bone where it angles outward, or a naturally prominent fifth metatarsal head. An unusual angle of the fifth metatarsal bone in relation to the fourth metatarsal also contributes. These inherited characteristics make the outside of the foot more susceptible to pressure and irritation.
Foot mechanics, including pronation or supination, alter pressure distribution across the foot. Excessive pronation, an inward rolling of the foot, leads to increased stress on the outside edge of the foot, particularly at the fifth MTP joint. Conversely, an uncompensated varus position of the forefoot or rearfoot, where the foot leans outward, also places undue pressure on the little toe side. These biomechanical imbalances cause the fifth metatarsal to rotate or bow laterally, contributing to the outward protrusion.
External Factors
External influences and lifestyle choices contribute to the formation and worsening of tailor’s bunions. Footwear plays a large role, especially shoes with narrow toe boxes, pointed toes, or high heels. Such shoes compress the forefoot, forcing the little toe inward and putting excessive pressure on the outside edge of the foot. Heels exceeding two inches exacerbate the condition by shifting weight forward and crowding the toes.
Occupations or activities that involve prolonged standing or repetitive pressure on the outside of the foot also cause or aggravate tailor’s bunions. The constant friction and compression from ill-fitting shoes during these activities irritate the fifth metatarsal head, leading to discomfort and gradual bony enlargement.
Progression of a Tailor’s Bunion
The anatomical factors and external pressures described in previous sections contribute to the progression of a tailor’s bunion, a cumulative process. Chronic irritation and persistent pressure on the fifth metatarsal head cause inflammation of surrounding soft tissues. This irritation can lead to bursitis, an inflammation of the bursa (a small, fluid-filled sac that cushions the joint). The body forms this bursa initially to protect the area from pressure, but with ongoing irritation, it becomes inflamed and painful.
Over time, this continuous pressure and inflammation stimulate bone remodeling, leading to the gradual enlargement of the fifth metatarsal head. The constant rubbing against footwear also causes the skin over the bunion to become irritated, red, or develop thickened areas like calluses. As the deformity progresses, the little toe may also deviate inward, further altering foot alignment and increasing discomfort and difficulty with wearing shoes.