A tailor bunion, formally known as a bunionette, is a common foot deformity affecting the joint of the little toe on the outer side of the foot. It is characterized by a painful, swollen bump at the base of the pinkie toe. Unlike a traditional bunion, which forms on the big toe, the tailor bunion occurs on the opposite side of the forefoot. This prominence can gradually increase in size, leading to discomfort and difficulty wearing certain types of footwear.
Defining the Tailor Bunion
A tailor bunion represents an enlargement or lateral deviation of the fifth metatarsal head, the long bone connecting to the little toe. This bony prominence forms where the fifth toe meets the foot, creating a visible bump on the outside edge. Symptoms include localized pain, especially when the area is compressed by footwear.
Friction over the enlarged joint often causes redness, inflammation, or the development of a callus. In some cases, an inflamed fluid-filled sac, known as a bursa, causes additional swelling and tenderness. The little toe may also begin to turn inward toward the fourth toe as the metatarsal bone shifts outward.
Identifying the Underlying Causes
The development of a tailor bunion is often linked to an inherited faulty mechanical structure within the foot. Certain foot types, such as those with a splayed forefoot or an abnormal positioning of the fifth metatarsal bone, predispose an individual to this deformity. A protruding fifth metatarsal bone can naturally cause the little toe to move inward over time.
This structural predisposition is frequently exacerbated by extrinsic factors, most notably restrictive footwear. Shoes with narrow toe boxes, pointed tips, or high heels place continuous, excessive pressure on the outside edge of the forefoot. This constant compression pushes the joint out of its natural alignment, accelerating the progression of the bony prominence.
Non-Surgical Management Strategies
Initial management of a tailor bunion focuses on conservative measures without correcting the underlying bone structure. The most immediate action is to modify footwear by choosing shoes with a wide toe box and avoiding narrow styles or high heels. Footwear made of soft, pliable materials can also reduce friction against the bony bump. Applying ice to the affected area for short intervals helps decrease localized swelling and inflammation.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to manage pain and reduce inflammatory symptoms. Protective padding, such as silicone bunion pads or moleskin, can be placed over the bump to cushion the area and prevent direct friction from shoes. For individuals with biomechanical issues, custom-made orthotics help redistribute pressure away from the fifth metatarsal head and provide better foot support. These strategies aim to provide substantial symptom relief, allowing the patient to maintain comfortable daily activity.
When Surgical Intervention is Required
Surgical correction is reserved for cases where the pain is persistent and severe, despite a dedicated trial of conservative treatments. Surgery is required when the bunionette significantly interferes with walking or the ability to wear supportive shoes. The primary goal of a surgical procedure is to correct the alignment of the fifth metatarsal bone and eliminate the painful prominence.
One common surgical approach involves an osteotomy, where the surgeon cuts and realigns the fifth metatarsal bone into a corrected position. This realignment is secured with small screws or pins that stabilize the bone as it heals. In less severe cases, a simple bunionectomy, or shaving away of the bony prominence, may be performed without cutting the bone itself. The specific procedure is determined by the severity of the deformity and the degree of angulation of the metatarsal bone to restore the foot’s contour and function.