A bunionette, or Tailor’s Bunion, is an enlargement of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The enlargement that characterizes a bunionette occurs at the metatarsal "head," located at the far end of the bone where it meets the toe. Bunionettes are not as common as bunions, which occur on the inside of the foot, but both are similar in symptoms and causes.
Often a tailor's bunion is caused by an inherited faulty mechanical structure of the foot. In these cases, changes occur in the foot's bony framework that result in the development of an enlargement. The fifth metatarsal bone starts to protrude outward, while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it. Sometimes a tailor's bunion is actually a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head. Heredity is the main reason that these spurs develop.
The symptoms of tailor's bunions include redness, swelling, and pain at the site of the enlargement. These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation. Regardless of the cause, wearing shoes that are too narrow in the toe, producing constant rubbing and pressure, usually aggravate the symptoms of a bunionette. In fact, wearing shoes with a tight toe box can make the deformity get progressively worse.
A bunionette is easily diagnosed because the protrusion is visually apparent. X-rays may be ordered to help determine the cause and extent of the deformity
Treatment for bunionettes typically begins with non-surgical therapies. Your foot and ankle surgeon may select one or more of the following options:
- Shoe modifications - Wearing the right kind of shoes is critical. Choose shoes that have a wide toe box, and avoid those with pointed toes or high heels.
- Oral medications - Nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve the pain and inflammation.
- Injection therapy - Injections of corticosteroid are commonly used to treat the inflamed tissue around the joint.
- Padding - Bunionette pads placed over the area may help reduce pain. These pads are available from your foot and ankle surgeon or at a drug store.
Surgery is often considered when pain continues despite the above approaches. Surgery is highly successful in the treatment of bunionettes. Surgery usually involves either cutting the 5th metatarsal and realigning it or ‘shaving’ the bone to remove the bump. The type of surgery depends on the extent of the deformity. The procedure is done as an outpatient and weight bearing is usually allowed immediately with a protective shoe. Full recovery is achieved by 3 to 4 months.