A bony prominence on the outside of the foot is a deformity known as a bunionette, or historically, a Tailor’s Bunion. Unlike the common bunion affecting the big toe (Hallux Valgus), this condition involves a structural change at the base of the little toe. Located on the foot’s lateral side, a bunionette can cause significant pain and discomfort, requiring specific approaches for diagnosis and management.
Understanding the Tailor’s Bunion
The Tailor’s Bunion is an enlargement that forms at the fifth metatarsophalangeal (MTP) joint, which is the joint where the little toe connects to the foot’s long bones. This deformity is a protrusion of the head of the fifth metatarsal bone on the foot’s lateral side. This bony growth makes the forefoot wider, often leading to friction against footwear.
The name “Tailor’s Bunion” comes from a historical link to the profession of tailoring. Tailors traditionally sat cross-legged while working, a posture that placed constant pressure on the outside edge of the foot, which eventually led to the development of this bony bump. The condition is often referred to as a bunionette because it is essentially a miniature version of the more common bunion.
The deformity involves the fifth metatarsal bone protruding outward while the little toe moves slightly inward toward the fourth toe. This misalignment creates the visible bump on the foot’s outer side.
Key Causes and Contributing Factors
The causes of a bunionette involve inherited structural factors and external biomechanical influences. Many cases stem from the inherited shape of the foot’s bones. For example, a foot structure that causes the fifth metatarsal to bow outward or a splayed foot can predispose an individual to this condition.
A significant anatomical factor is an increased angle between the fourth and fifth metatarsal bones, known as the intermetatarsal angle. This wider separation pushes the head of the fifth metatarsal further out, creating the prominence. This structural issue, combined with inherent foot mechanics, is the primary underlying cause.
External factors, particularly footwear, aggravate the condition. Shoes with a narrow or pointed toe box squeeze the forefoot, applying constant pressure to the fifth MTP joint. This chronic compression is a major contributing factor, which is why bunionettes are seen more often in women than in men.
Recognizing Symptoms and Medical Confirmation
The most obvious symptom is the presence of a noticeable bony lump on the outside of the foot at the base of the little toe. This protrusion often becomes painful, especially when rubbing against tight or constricting footwear. The area around the bump may also show signs of inflammation, including redness, swelling, and aching pain.
Chronic friction can lead to the formation of thickened skin, such as corns or calluses, over the bony prominence or on the side of the little toe. Discomfort typically worsens with activity or prolonged standing. Pain may also occur on the sole of the foot if the deformity alters the patient’s walking gait and pressure distribution.
Medical confirmation begins with a physical examination where a healthcare provider assesses the foot’s structure and reviews symptoms. The provider looks for the characteristic prominence and may test the range of motion of the little toe joint.
X-rays are a necessary diagnostic tool used to visualize the underlying bone structure. Radiographic images help determine the exact degree of the deformity by measuring the angular deviation of the metatarsal bones. This measurement is essential for classifying the severity of the bunionette and confirming whether the issue is a true bony enlargement.
Management and Treatment Pathways
Initial management focuses on conservative, non-surgical methods aimed at relieving pain and preventing progression. This involves changing footwear to shoes with a wide, deep toe box that does not compress the forefoot. Avoiding high heels and narrow, pointed-toe styles significantly reduces pressure on the bunionette.
Other non-surgical treatments include using over-the-counter bunion pads or cushioning devices to protect the area from shoe friction. Applying ice and taking Nonsteroidal Anti-inflammatory Drugs (NSAIDs) may be recommended to manage pain and reduce localized swelling. Custom-made orthotics can also be helpful by addressing underlying biomechanical issues, such as a flexible flatfoot.
These conservative measures alleviate symptoms and slow the progression of the deformity, but they cannot reverse the underlying bony change. Surgery becomes an option when non-surgical treatments fail to provide adequate pain relief, or when the deformity causes persistent discomfort or difficulty wearing shoes.
The goal of surgical intervention, often called an osteotomy, is to realign the fifth metatarsal bone and reduce the foot’s width. This procedure involves cutting and repositioning the bone to correct the abnormal angle and remove the bony prominence. The general pathway is to correct the faulty mechanical structure to provide a lasting solution.