Tailors' Bunions/Bunionettes

As a podiatrist in Toronto, I have the opportunity to see many patients with bunionettes or tailor's bunions in my Toronto foot clinic. A bunionette or tailor's bunion is a bony enlargement which occurs at the lateral or outer side of the 5th metatarsal head, just before the baby toe. It is said that tailors work with their legs crossed and their hips turned out which causes pressure at the lateral side of their foot with the resultant formation of the bunionette. Tailor's bunions or bunionettes can involve  soft tissue and the bone.

Tailor's bunions or bunionettes can be associated with a splayed foot type. This is the kind of foot where the metatarsal bone splay during weight bearing causing the foot to become wider when you stand and walk. Some people with tailor's bunions or bunionettes also have bunions at the inner side of the foot, just before the big toe. In addition, bunionettes can also be found in conjunction with hammertoes or contracted toes.

People with bunionettes often complain of pain at the 5th metatarsal head and swelling. The area may be red. It is often aggravated by shoes, especially during walking. As I mentioned before, it can be seen alone or with other foot deformities.

The deformity is often due to a hereditary biomechanical problem. In other words., if you have a tailor's bunion, maybe one of your parents or grandparents also have the same deformity. Various authors attribute the cause to a poorly developed transverse metatarsal ligament,  the improper insertion of the transverse head of the adductor hallucis muscle, hypertrophy or excessive thickness of the soft tissue at the side of the 5th metatarsal head, a wide fifth metatarsal head as well as lateral bowing or bending of the 5th metatarsal shaft. It is also believed that excessive pronation can contribute to the prominence at the 5th metatarsal head which is then aggravated by shoes.

When you come to see me with your painful bunionette, I will check to make sure that there is no abnormal  soft tissue or bone growth, that there is no evidence of inflammatory or degenerative joint disease, no neurological issues, and no local manifestations of other medical problems.

I will take a careful history and perform a physical examination of your foot. I will evaluate the location and duration and intensity of your pain as well as the degree of functional disability. I will also talk to you about your shoe ware. I will examine your foot off weight bearing and while you are walking. I will take X-rays of both of your feet to compare them and to evaulate them for such things as a bone growth, old fractures, as well as soft tissue inflammation and calcifications. I will also evaluate the position fo the 5th metatarsal relative to the 4th metatarsal and look for bending of the 5th metatarsal away from the 4th metatarsal. I will look for signs of other deformities such as bunions and contracted toes.

Non-surgical treatment or conservative treatment includes made to measure orthotics to improve mechanics that contribute to the problem, pads, and suggestions regarding shoes.

Treatment

In most cases, surgical treatments involve either removing the bump or making the metatarsal straighter by cutting through it and repositioning it. Over the years, I found that simply removing the bump, in many cases, will not give a good cosmetic result. It is usually necessary to reposition the metatarsal straighter by cutting through it and resetting it.

Traditionally, this meant going to the hospital, being put to sleep, making a long incision and cutting through all the soft tissues to get access to the bone. This resulted in a lot of soft tissue trauma, pain and swelling. Casts and screws were often used and the patient was unable to walk for six weeks or more. However, due to minimally invasive techniques developed by podiatrists, tailor's bunions or bunionettes can be treated under local anaesthetic in an office-based setting. Specialized instruments are used to correct deformities through very small openings in the skin. This results in much less soft tissue trauma, and in most cases, much less pain and swelling. Casts are not necessary, screws do not have to be left in the foot, and you can walk immediately, although you will have to reduce your activities for approximately six weeks. Instead of a cast, I use an adhesive tape dressing which is changed weekly until six weeks are up. I then see patients every three months for a year to check to see that the foot is healing properly.

If you, or a loved one, has a tailor's bunion, a bunionette or other foot problems, please call my office at 416-486-9917 for a private consultation to find out how you can be helped to walk pain-free.