A Tailor’s Bunion, or bunionette, is a structural deformity affecting the side of the foot. This condition creates a noticeable bump on the foot’s outer edge, specifically at the base of the little toe, leading to irritation and discomfort, especially when wearing shoes.
Defining the Bunionette
A Tailor’s Bunion is an enlargement or bony prominence located at the joint at the base of the little toe, specifically the head of the fifth metatarsal bone. This deformity involves a structural shift where the fifth metatarsal bone protrudes outward, while the pinky toe angles inward toward the fourth toe. The term “bunionette” is used because it is similar to the common bunion, but localized to the small toe.
The historical name originated centuries ago from tailors who sat cross-legged while working. This posture caused the outside edge of the foot to constantly press against the ground, putting chronic pressure on the fifth metatarsal joint. This pressure likely contributed to the development of the bump. A bunionette differs from a regular bunion (Hallux Valgus) in location; the latter occurs on the inside of the foot at the base of the big toe.
Primary Contributing Factors
The initiation and acceleration of a Tailor’s Bunion are linked to a combination of inherited foot structure and external mechanical forces. Many individuals have an inherited faulty mechanical structure that makes them prone to bunionettes. This may include a naturally splayed forefoot, a fifth metatarsal bone with an increased lateral curve, or an abnormally prominent fifth metatarsal head. These genetic factors position the bones in a way that increases lateral pressure on the joint.
External pressure, particularly from footwear, acts as a significant accelerating factor for the deformity. Shoes featuring a narrow toe box or pointed toes force the little toe inward, creating continuous pressure on the fifth metatarsophalangeal joint. High-heeled shoes also worsen the problem by shifting body weight onto the forefoot, further compressing the metatarsal bones. This constant friction and compression irritates the joint and hastens bone misalignment.
Gait mechanics, or the way a person walks, also play a role by unevenly distributing weight across the foot. Abnormal foot mechanics, such as excessive supination (rolling the foot outward) or pronation (rolling the foot inward), alter the distribution of weight and stress. These biomechanical irregularities can cause increased lateral pressure on the fifth metatarsal during the push-off phase of walking, straining the outer edge of the foot.
Recognizable Symptoms and Progression
The most apparent symptom is the visible bony protrusion on the outer side of the foot at the base of the little toe. This enlargement is accompanied by localized pain and tenderness, aggravated by walking or wearing restrictive shoes. The skin overlying the bony bump often becomes red and inflamed due to constant rubbing and pressure from footwear.
Continuous friction can lead to the formation of a thickened layer of skin, such as a callus or corn, directly over the joint. Swelling around the joint is also common, indicating soft tissue inflammation. If underlying causes are not addressed, the condition is progressive; the deformity and misalignment will worsen over time. This progression leads to chronic inflammation, difficulty finding comfortable shoes, and changes in gait as the person compensates for the pain.
Non-Invasive Management Strategies
Managing discomfort and slowing progression centers on mitigating pressure and mechanical factors that aggravate the joint.
Footwear Modification
A primary step involves consistently choosing shoes with a wide toe box and lower heels. This reduces compressive forces and friction against the bony prominence, a major source of pain. Softer shoe materials are also helpful as they conform more easily around the deformity than stiff materials.
Padding and Pain Relief
Protective padding, such as moleskin, felt, or gel pads, can be used directly over the bunionette to create a barrier against the inside of the shoe. For managing inflammation, applying an ice pack can reduce swelling and tenderness. Over-the-counter anti-inflammatory medications may also be used temporarily to alleviate pain.
Biomechanical Support
For issues related to faulty gait mechanics, custom or prefabricated orthotics can be incorporated into footwear. These specialized inserts align the foot bones and redistribute pressure away from the outside edge of the foot. Addressing biomechanical imbalances reduces strain on the fifth metatarsal joint, slowing the deformity’s progression. Taping or bracing the little toe may also be used to help maintain better alignment.