A tailor’s bunion, medically known as a bunionette, is a common foot deformity that causes discomfort and difficulty with shoe wear. It is essentially a smaller version of the more familiar bunion, but it forms on the opposite side of the foot. The condition is progressive, meaning it tends to worsen over time without proper management.
Anatomical Definition and Recognizing the Deformity
A tailor’s bunion is a bony enlargement or a lateral deviation of the fifth metatarsal head, which is the long bone connecting the ankle to the little toe. The deformity manifests as a prominent bump on the outside edge of the foot, specifically at the fifth metatarsophalangeal (MTP) joint, where the pinky toe meets the rest of the foot. The little toe itself often begins to deviate inward, pointing toward the fourth toe, as the metatarsal bone shifts outward.
The most recognizable symptom is a noticeable bony lump on the side of the foot. This protrusion frequently rubs against footwear, leading to localized pain, inflammation, and redness. Swelling around the joint is common, and the constant friction can cause the skin to thicken, resulting in the formation of calluses or corns directly over the bony prominence. Pain is often most pronounced when wearing restrictive shoes, as the pressure on the misaligned joint increases.
Contributing Factors and Genetic Predisposition
The historical name, tailor’s bunion, is derived from the way tailors traditionally sat cross-legged, placing excessive pressure on the outside edge of the foot for extended periods. Today, the primary mechanical factor is often improper footwear, particularly shoes with a narrow toe box that compress the forefoot and push the fifth metatarsal head laterally. High-heeled shoes can also exacerbate the problem by forcing the foot forward and increasing pressure on the toes.
While external pressures contribute to the condition, the underlying architecture of the foot is a significant factor. A structural or inherited predisposition is common, meaning an individual may have an inherent foot shape that makes them more susceptible. This includes congenital issues like an abnormal position of the fifth metatarsal, a genetically wider forefoot, or a splayed foot. Biomechanical abnormalities, such as an unusual gait or excessive motion, also contribute by causing uneven pressure distribution.
Non-Surgical Management Strategies
The first and most effective line of defense for managing a bunionette is modifying footwear to alleviate pressure on the fifth MTP joint. Choosing shoes with a wide, deep toe box is paramount, as this prevents the compression that irritates the bump. Avoiding high heels and shoes made of hard, unyielding materials is also advised, opting instead for soft leather or fabric uppers that can accommodate the deformity.
Various protective padding options can be used to cushion the area and reduce friction against the shoe. Silicone bunion pads or foam padding can be applied directly over the prominence to provide a buffer. Over-the-counter or custom-made orthotic devices may also be recommended to correct underlying biomechanical imbalances and redistribute pressure away from the affected area.
Symptomatic relief focuses on reducing pain and inflammation.
Pain and Inflammation Reduction
- Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and inflammation around the joint.
- Applying ice packs to the area for 15 to 20 minutes several times a day decreases swelling and localized tenderness.
- Physical therapy exercises, such as toe curls and calf stretches, help strengthen muscles and improve flexibility.
- For persistent, severe inflammation, a physician may suggest a corticosteroid injection directly into the bursa, the fluid-filled sac that can become inflamed over the bony bump.
When Surgery Becomes Necessary
Surgical intervention is typically considered only after a prolonged period of conservative management has failed to provide sufficient pain relief. The primary criteria for moving toward surgery include persistent, debilitating pain that interferes with daily activities and the inability to wear even comfortable shoes. Surgery is also warranted if the deformity is severe enough to cause significant misalignment or functional impairment of the foot.
The goal of surgical treatment is to realign the fifth metatarsal bone and permanently eliminate the bony protrusion. The most common procedure is an osteotomy, where the surgeon cuts the metatarsal bone and repositions it into a more anatomically correct alignment. Small screws, wires, or pins are then used to stabilize the bone while it heals in its new position. For less severe cases, a simpler exostectomy may be performed, which involves shaving or removing only the bony bump without cutting the metatarsal.
Recovery involves a period of non-weight-bearing or limited weight-bearing in a protective surgical shoe for several weeks. Patients are often advised to elevate the foot to manage swelling in the initial days following the procedure. The total recovery period, including the return to normal activities and comfortable shoe wear, typically spans six to twelve weeks, depending on the specific procedure performed and the patient’s healing rate.