What is a bunionette or Tailor’s bunion?
Ever hear the saying that good things come in small packages? Well, that certainly isn’t the case when it comes to bunionettes. Also known as “tailor’s bunions,” bunionettes are a painful bony overgrowth that forms at the base of the pinky toe (fifth toe) along the lateral border of the foot.
In anatomical terminology, bunionettes form at the joint at the base of the small toe formed by the distal end of the fifth metatarsal bone (a long bone of the forefoot) and the initial bone segment of the small toe.
Bunionettes got the moniker “tailor’s bunions” because persons who regularly place pressure on the outside of the foot, are at greater risk of developing a protruding bone on the outside of the foot that can cause pain. Just like tailors in olden days sitting crossed legged with the outer edge of their foot rubbing the ground.
What causes a bunionette deformity?
Bunionettes form in much the same way as bunions do: continuous pressure that’s placed on the little toe can eventually lead to the formation of a tender bony mass. Over time, the overlying skin will thicken or perhaps even form calluses, causing a visible deformity that can become painful. In extreme cases, the small toe will start to rotate inward.
More common risk factors for developing bunionettes nowadays include wearing tight shoes, such as high heels that can place increased pressure on the small toes, or wearing shoes with a narrow toe box. These folks are also at greater risk of developing bunions.
In very rare circumstances bunionettes may be caused by congenital problems (those present at birth) or by medical conditions like rheumatoid arthritis that can cause deformity of the long bones in the forefoot (the metatarsals).
What are the symptoms of a bunionette?
Symptoms of a bunionette include:
- A visible lump on the outer edge of the base of the small toe (the fifth metatarsophalangeal joint)
- Pain localized to the joint between the small toe base and the fifth metatarsal head that occurs when something presses against the bump
- Inward rotation of the small toe
- Redness at the base of the little toe
- Soft tissue swelling at the base of the small toe
- A callus forming at the base of the small toe (known as a tailor’s bunion callus)
Interestingly, not all bunionettes are painful. In fact, during their early stages, bunionettes may be visible before they start becoming symptomatic. Obviously, the sooner bunionettes are treated, the higher the likelihood that the treatment will succeed.
How can I confirm if I have a bunionette?
Just as with bunions (hallux valgus) that affect the big toe, the signs of a bunionette deformity at the little toe are fairly easy to see. A trained podiatrist can confirm the diagnosis after examining your foot. An x-ray might be ordered to determine the extent of joint involvement that can guide how to best treat the condition.
Is surgery the only way to treat bunionettes?
No! The good news is that most bunionettes often do well with conservative treatment. The obvious first step in tailor’s bunion treatment is to prevent bunions from getting worse by removing pressure from the base of the small toe and alleviating the pain (if you have any).
Conservative treatments for bunionettes include:
Switch to shoes with a wide toe box or, in warm climates, switching to sandals that apply no pressure to the area. Avoid pointy-toed shoes (like cowboy boots) and high heeled shoes that thrust your weight onto the ball of your foot. In some cases, you might need to go up one shoe size to get a roomier toe box.
Alternatively, your foot and ankle specialist might suggest using over-the-counter pads or custom-made orthotics to reduce pressure on the small toe joint. It’s important that the toe box of your shoe is roomy enough to accommodate the tailor’s bunion pad without increasing the pressure placed on the bunionette.
Intermittently applying an ice pack for 20-minute intervals, several times per day. To avoid freezer burns resulting from direct contact of ice on the skin, wrap the ice cubes or gel pack in cloth.
NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen, naproxen, Advil, or Aleve can help with swelling. Never take these on an empty stomach as they can cause gastrointestinal bleeding if you are not careful.
Chronic pain might warrant treatment with steroids to decrease inflammation directly at the site.
When is surgery recommended for a bunionette?
Just as with a traditional bunion, the main reason to have correction surgery is to alleviate pain and improve function. In the rather rare event of a patient having a severe bunionette with painful internal rotation of the small toe that has failed conservative treatment, we might recommend a minimally invasive surgery to realign the small toe.
The surgical approach recommended by your doctor will be based on a combination of factors, including the joint wear demonstrated on x-ray findings, your age, activity level, lifestyle, and any underlying medical conditions. Of course, the recovery time after a tailor’s bunion surgery will be determined by the surgical approach selected.
Why choose the Bunion Institute for your bunion treatment or surgery?
If you’re experiencing bunion pain, we’re here to help. Our nationally recognized foot and ankle podiatry experts offer the most advanced bunion solutions and the highest success rates in the nation. We are leaders in the research and treatment of all bunion conditions.
At the Bunion Institute (an affiliate of the University Foot and Ankle Institute), we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.
To schedule a consultation, please call (855) 872-5249 or make an appointment now.
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