No, this isn’t a bunion belonging to a famous pop country singer; a tailor’s bunion, also called a bunionette, is basically your average bunion, or bony prominence, just on the outside of your foot. It’s a structural deformity of the 5th metatarsal. Bunionettes cause irritation to and pinching of the soft tissue on the side of the foot, typically causing enough pain and discomfort to bring the patient in to seek treatment. Because the underlying cause of tailor’s bunions is internal, conservative treatments involving debriding calluses or using gel pads don’t effectively “cure” the bunionettes.
If you’re a patient with a bunionette, you probably have pain, either isolated to the 5th metatarsal head, or sometimes involving the 5th toe as well. Shoes typically increase the pain, and walking barefoot typically relieves pain. A bursa, or fluid filled sac forming next to the bone, will cause increased swelling, warmth and redness about the bony prominence. There may also be hyperkeratosis (callus) in the area, increasing the pressure and pain in the area. You may also have a rotated and turned in 5th toe, and an accompanying corn on that turned in toe.
Numerous theories exist to explain the development of the tailor’s bunion:
– weak ligaments between the metatarsals
– congenital bowing of the 5th metatarsal
– congenitally large 5th metatarsal head
– splay foot
– shoe impingement (wearing shoes that are too tight)
– sitting cross-legged (the reason these little bunions are called “tailor’s bunions,” as tailor’s would work sitting cross-legged)
– increased angle between the 4th and 5th metatarsal
– hypertrophy of the soft tissue structures about the 5th metatarsal head
Regardless of underlying cause, the bony prominence of the 5th metatarsal head produces soft tissue irritation that results in bursa or keratosis (callus) formation (ouch!) Deformities of the 5th toe are usually present and may also contribute. Rarely, systemic disease, arthridities, and neoplastic disease (cancer) may be a cause of tailor’s bunion.
There is more motion at the 5th metatarsal compared to the 2nd-4th, and it has its own axis of motion. Pronation will cause the 5th metatarsal head to become more prominent on the top and outside of the foot giving rise to the bunionette. A tailor’s bunion is seen more commonly in individuals who pronate throughout gait.
Sometimes, you don’t want to have surgery, or you can’t take time off work to have the surgery. Conservative treatments for a tailor’s bunion are simple, palliative (treat the symptoms, not the cause), and won’t truly do anything to reverse the underlying cause, or prevent progression of the problem. Simple fixes like this gel pad are easily purchased either at your podiatrist’s office, the pharmacy, or a shoe store. If a callus is also present, routine callus trimming can prevent further pressure from the callus. However, although these treatments may temporarily alleviate the pain from the bunionette, they will not decrease the size of the bunion, or make it go away.
Surgery is the best treatment for a tailor’s bunion. Depending on the type of pain and main complaint the patient has, a surgeon will determine the best procedure for each case. Depending on the procedure performed, and patient specific concerns, the patient may have anywhere from 2-8 weeks of non– or partial weight-bearing to look forward to after the surgery to properly heal. Procedure selection and options should be discussed with your podiatric surgeon.