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While many may be familiar with the classic bunion that appears at the base of the big toe, a very similar condition can develop at the base of the little toe. This condition is known as a tailor’s bunion, sometimes referred to as a “bunionette”. A tailor’s bunion is an enlargement of the fifth metatarsophalangeal joint (MTPJ) and the lateral aspect of the fifth metatarsal head, whereas a classic bunion is on the first MTPJ. The development of a tailor’s bunion is similar to that of a bunion, and they are often seen together.
The development of tailor’s bunions are most commonly attributed to pathological pronation, sometimes referred to as “over-pronation” or “pronation syndrome”. Due to improper biomechanics of the foot, muscle imbalances can occur, and the fifth toe can begin to rotate in a number of ways. This rotation can cause increased forces on the lateral side of the fifth metatarsal and fifth MTPJ, causing an increase in bony growth that results in a tailor’s bunion. Wearing tight and poorly fitting shoes can exacerbate the problem, leading to pain and deformity. It is also common to find corns and calluses in association with tailor’s bunions, which are often painful.
The diagnosis of a tailor’s bunion is made clinically, though an x-ray is often required to assess the extent of the deformity. Conservative treatment of tailor’s bunion is focused on pain reduction, as well as prevention of furthering of the deformity. This may include measures such as anti-inflammatory medications (usually NSAID’s), wider shoes, padding taping, and the use of custom orthotics.
When conservative treatment fails, or if a patient desires that the bump be removed, surgical treatment may become an option. Several different surgical procedures are available for tailor’s bunions, with the extent of the deformity dictating which procedure is selected by the surgeon. Most procedures focus on removing the protruding bump from the bone, as well as realigning the bone so that the painful deformity does not recur.
Depending on which surgery is performed, it may or may not be possible to be walking on the foot right away. Typically when the fifth metatarsal is realigned at the head (the area closest to the toe) the patient will be able to walk in a surgical shoe right away. For surgeries performed at the shaft or the base of the metatarsal, crutches or a non-weight bearing shoe may be required for two weeks. Minimal pain and swelling is anticipated in most cases, and studies show a predictable and effective outcome for most surgeries.
