What is a Bunionette (or Tailor’s Bunion)?

A bunionette (also called a Tailor’s Bunion) is an abnormal bump that appears at the end of the fifth metatarsal (bone of the foot). The bump develops as a result of an enlarged portion of the fifth metatarsal head. It is similar to a bunion, which occurs at the end of the big toe, whereas a bunionette occurs beside the little toe.

The term Tailor’s Bunion came about because tailors traditionally sat cross-legged on hard surfaces for long periods of time. The outside of their feet were subjected to excessive pressure, and as well as the constant friction they experienced while in this position. This led to a painful bump at the end of the fifth toe.

Like bunions, bunionettes are more prevalent among older individuals.  According to the Journal of Foot and Ankle Research, 25% of people between the ages of 18-65 years of age have bunions and 67% of the sufferers are over the age of 65.  However, a report by Wall Street Journal revealed that a growing number of younger women also suffer from bunions.

Causes

Often, the condition is caused by wearing inappropraitely narrow shoes that force the toes to squeeze into a pointed toe box. This is further complicated with the use of high heels. These shoes put pressure on the metatarsal joint, thereby aggravating the condition. According to the American Orthopaedic Foot and Ankle Society, about 8o% of women in the United States wear shoes that either hurt their feet, or are too small. That is a contributing factor to the higher incidence of bunionettes among women than in men. In fact, a study revealed that 50% of U.S. women have bunions or bunionettes. Men’s shoes are generally built for a higher degree of comfort, so they are less likely to develop bunions that become problematic.

Apart from shoes, bunions can also develop as a result of your foot type, which can be genetic. The changes in your foot’s bone alignment can become enlarged, making the fifth metatarsal bone to protrude on the outside, while the little toe moves towards the foot’s middle line. This causes a bump to appear on the foot’s surface, which becomes irritated as the shoe rubs against it.

Symptoms

At the onset, a bunionette is not painful, though its appearance as a mild bump may be a concern. However, as time passes, the ligaments that connecting the toes will start to stretch out and the tendons of the fifth toe will begin to pull away from the fourth toe. At this stage, a bump enlarges and the bony prominence and inflammation of the joint capsule, or inflammation of a bursa, can trigger pain. As the bunionette grows, the fifth toe begins to appear increasingly crooked and the severity of the protrusion can make it difficult to wear shoes which apply direct pressure to the area. If left untreated the onset of arthritis in the fifth toe joint can further aggravate the condition. Some patients also experience an ulcer at the site. Pain associated with a Tailor’s Bunion may change the way a patient walks, which can in turn lead to discomfort in the lower back, hips, knees and ankles.

Treatment

Bunionette treatment is performed to restore the natural alignment of the foot bones. Medical professionals and educators advise early treatment of bunions or bunionettes. The first recommended treatment for this condition is to totally avoid footwear that squeezes or pinches the toes. Patients are advised to wear shoes that have a wide toe box and little or no heel height.

Harvard medical school and the American Podiatric medical Association (APMA) advise those with a bunionette to use a semi soft orthotic insert. Orthotic inserts are often successful in helping to correct the position of the foot as it hits the ground. You can also try padding and taping or the use of a splint to reduce the pain. Other recommended treatments are icing, injection therapy and anti-inflammation drugs and supplements. These conservative treatments may help alleviate the pain associated with a Tailor’s bunion, and may even slow its progression.

Surgery is only recommended for patients whose symptoms are severe to the extent that they find it difficult to perform their normal day to day activities, or even wear appropriate footwear without pain. These patients have typically tried several of the conservative approaches, and opt for surgery when they no longer find relief or want to avoid further complications.

Surgery involves addressing the characteristic bunionette deformities, such as the enlarged bump, crooked fifth toe, or the misaligned metatarsal bone. The procedure centers on working with the soft tissues around the area, cutting the fifth metatarsal bone, realigning it and then re-attaching everything with screws, wires, plates or pins. Most patients can walk to some degree after the procedure, though it may takes 6-8 weeks to be able to walk normally.

At Houston Foot and Ankle Care, we have treated Tailor’s bunions to great success, helping patients get back to their daily activities by correcting the bunion deformity. Dr. Gabriel Maislos is a recognized Houston podiatric surgeon, who understands that living with any foot discomfort is not normal. If you’re dealing with a painful Tailor’s bunion, or any other foot or ankle issues,  schedule an appointment by calling us at (713) 541-3199 today.

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Houston Foot and Ankle

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