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Tailor's Bunion

A Tailors bunion (also called a bunionette) is a bony prominence that typically occurs on the outside side of the forefoot at the base of the fifth toe.

The bunion is not a growth of bone or a calcium deposit.  The bunion is actually the rounded end of the fifth metatarsal bone (the bone on the outside of the forefoot leading to the 5th toe) that is slowly splaying away from the outer side of the foot.

The condition is not always painful, but can be, if the deformity is large enough, activities are strenuous enough, or shoes are too tight, too pointed, or have heels that are too high.  When pain is present, it usually results from shoe pressure on the bunion.  Other times, pain can also occur at the bottom outside of the joint, where a callus can develop.

The condition usually develops slowly over a period of years.  The condition usually starts at a young age and slowly progresses over time, resulting in a deformity large enough to cause pain in the 40s or later.  However, the condition can occasionally be seen to progress more rapidly and become large enough to cause pain as early as the teens.  The condition can be found equally developed on both feet (symmetrical), but in other cases, one foot may have a more pronounced deformity than the opposite foot (asymmetrical).

The condition develops as a result of abnormal mechanics of the foot in general and the fifth metatarsal bone in particular.  The biggest factor that plays a role in determining abnormal foot mechanics is heredity.

Factors that can lead to a painful Tailors bunion

  • Heredity / Abnormal mechanics of the foot
  • Fifth metatarsal bone lower than normal (plantarflexed)
  • Foot that leans to the outside (inverted foot)
  • Ligamentous laxity (loose ligaments / splay foot)
  • Poor shoes – especially tight shoes, pointy shoes, and high heels
  • Tight calf muscle

Treatment of the condition falls into non-surgical and surgical categories.  The goal of non-surgical treatment is to eliminate pain.  The goal of surgical treatment is to eliminate pain and correct the deformity.  Non-surgical treatment usually does not correct the deformity.

Non-surgical Treatment

 Wear appropriate shoes.  The shoes should have ample toe box width and should be made of soft upper materials.  High heels must not be worn.  Purchase your shoes only after being properly measured for your length and width, and preferably later in the day.
 Have your shoes stretched at a shoe repair shop.  Ask the shoe repairperson to “spot stretch” just the spot on the shoe that is overlying the bunion.  Some people have also obtained great relief by cutting an x in the shoe at the spot that overlies the bunion.
 Use padding.  Silicone gel bunion guard (a silicone gel pad for the bunion area) is recommended.
 Perform calf stretching exercises for 30-60 seconds on each leg at least two times per day.  (Stand an arm’s length away from the wall, facing the wall. Lean into the wall, stepping forward with one leg, leaving the other leg planted back. The leg remaining back is the one being stretched. The leg being stretched should have the knee straight (locked) and the toes pointed straight at the wall. Stretch forward until tightness is felt in the calf. Hold this position without bouncing for a count of 30-60 seconds. Repeat the stretch for the opposite leg.)
 Use ice on the painful area for 5-10 minutes, 1-3 times per day – especially in the evening.  Fill a styrofoam or paper cup with water and freeze it. Peel back the leading edge of the cup before application. Massage the affected area for 15-20 minutes.  CAUTION: AVOID USING ICE WITH CIRCULATION OR SENSATION PROBLEMS.
 Use an oral anti-inflammatory medication. (We recommend over-the-counter ibuprofen.  Take three 200mg tablets, three times per day with food – breakfast, lunch, and dinner.  To obtain the proper anti-inflammatory effect, you must maintain this dosing pattern for at least 10 days.  Discontinue the medication if any side effects are noted, including, but not limited to: stomach upset, rash, swelling, or change in stool color.  IF YOU TAKE ANY OF THE FOLLOWING MEDICATIONS, DO NOT TAKE IBUPROFEN: COUMADIN, PLAVIX, OR OTHER PRESCRIPTION OR OVER-THE-COUNTER ORAL ANTI-INFLAMMATORY MEDIACTIONS.  IF YOU HAVE ANY OF THE FOLLOWING HEALTH CONDITIONS, DO NOT TAKE IBUPROFEN: KIDNEY DISEASE OR IMPAIRMENT, STOMACH OR DUODENAL ULCER, DIABETES MELLITUS, BLEEDING DISORDER.)
 Keep any callus filed down using a pumice stone or callus file.

Surgical Treatment

 There are a number of different procedures that can be used for the surgical correction of Tailors bunions.  In some cases, the surgery involves simply “shaving off the bunion”.  However, more commonly, the surgical correction usually involves both, removal of the bunion and performing a repositioning bone cut to improve the alignment of the fifth metatarsal.  The specific nature of the surgery required for correction of your Tailors bunion is determined by an examination of your foot clinically and with x-rays.

Typically, the surgery is performed on only one foot at a time.  Usually bone screws are used to stabilize bone cuts and stay implanted permanently.  The surgery is usually performed on an outpatient basis.  Typically, you are allowed to bear weight on the foot after surgery (unless other surgical procedures were performed as part of your overall foot surgery). You may or may not be required to be in a cast.

Full recovery may take 4-6 months.  Depending on the type of work that you do, you will be advised to remain off work for as little as 2 weeks (for a completely sedentary job with no mobility requirements) to as much as 2-3 months (for a job that requires standing/walking).

The success rate is approximately 85%.  Approximately 12% are improved, but may still have some limitations or footwear or activities.  About 3% are no better or worse.  Risks include, but are not limited to: undercorrection, overcorrection, recurrent deformity, stiffness of the big toe joint, weakness of the toe, transfer of pain or callus to an adjacent bone or area, broken pins or hardware, intolerance of pins or hardware, delayed or non-healing of bone, nerve injury or entrapment, delayed incision healing, painful or unsightly scar, prolonged recovery, recurrent pain, incomplete relief of pain, no relief of pain, worsened pain, and circulation impairment or loss of the toe.