| What
is a bunionette or Tailor's Bunion?
A bunionette, also known as a Tailor's Bunion, is a bump that develops on the outside of the foot, near the base of the fifth toe. The bump is caused by an enlarged portion or misalignment of the bone (the fifth metatarsal head), and it is often associated with a misaligned 5th toe (the little toe). The diagram to the immediate right shows the enlargement as a result of a misaligned bone. The picture to the far right shows the typical clinical appearance. |
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The condition is analogous to a true bunion,
except it occurs on the side of the foot with the near the little toe,
whereas bunions occur on the side of the foot next to the big toe.
Bunionettes are usually a progressive problem, and can make it difficult to find shoes that fit. The condition is often quite uncomfortable.
What causes a bunionette or Tailor's Bunion?
Bunionettes can develop for several reasons, but a biomechanical abnormality (improper function of the foot) is the most common cause. In an unstable flat foot, for example, a muscular imbalance often develops that, over time, causes bunionettes.
Bunionettes tend to run in families, and most podiatrists believe that genetic factors play a role in predisposing some people to develop bunions.
Poor shoes--like high heels and pointed toe boxes--exacerbate the condition by speeding up the development of bunionettes, and by making them more painful. This is at least one of the reasons bunionettes are much more common in women than men.
What symptoms do people with bunionettes have?
Bunions typically start out as a
mild bump on the side of the foot, or an inward bending of the small toe. Bunionettes at this stage are usually only a concern of appearance at this stage, and at this point they often don't hurt much.Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the 5th toe gradually pull it farther and farther towards the 4th toe. Sometimes patients will find their 4th and 5th toes begin to press together too much, and they'll often get a painful corn between those toes.
Bump pain at the site of the bony enlargement on the side of the foot may develop. A painful bursa may develop at that site. This is particularly true in tight shoes.
Over time, with the 5th toe held in a crooked position for enough time, arthritis may develop in the 5th toe joint.
Pain associated with this condition may gait abnormalities, or changes in the way a patient walks, which may cause secondary pain in the legs, knee, hip, and low back.
How are bunionettes treated?
Bunionettes are progressive problems, meaning they tend to get worse over time. Sometimes severe-looking bunionettes don't hurt much, and sometimes relatively modest-looking bunionettes hurt a great deal. Thus, treatment varies depending upon a patient's symptoms.
You can often improve the discomfort of bump pain by a change to more proper shoes. Accommodative padding and various over-the-counter and custom-made orthoses and latex accommodative shields can also alleviate bunionette pain. Such devices don't correct bunionettes, but if properly designed and made, they can alleviate pain and/or slow their progression.
Often, though, when conservative measures fail to alleviate pain associated with the bunion, when you start to limit the types of activities you perform, when it's difficult to find comfortable shoes, and when arthritis changes how you walk, surgery may be the best alternative.
What does bunionette surgery involve?
There are quite a number of procedures designed to address bunionette deformities, and each have different indications. For example, some procedures simply address an enlarged bump. Some simply address the crooked fifth toe. Other procedures address the misaligned bone behind the fifth toe, the fifth metatarsal. But in order to slow the return of the bunionette deformity, most procedures aim to address each of these conditions.
Addressing the bump, the fifth toe, and the fifth metatarsal entails doing some work on the soft tissues surrounding the area, then cutting the fifth metatarsal bone, realigning it, then holding everything in place. How and where the fifth metatarsal would be cut is dependent upon each, individual case.
If the bones are cut and realigned, how do you hold them together?
Sometimes a screw is placed in the foot to hold a bone in a corrected position, other times a pin, wire or even a plate is chosen. There are even absorbable pins and screws, which are used for some patients. There may be some times when no materials are required to hold the bone together at all.
Is a cast used?
Procedures have evolved over the years in such a way that stable bone cuts and stable forms of fixation (ways of holding the bones together) that in the vast majority of cases casts are unnecessary. Today casts are used rarely, usually when
certain unstable bone cuts are chosen for one reason or another.Do patients need to be hospitalized?
No. Years ago patients were hospitalized for the procedure, but today, as a general rule, patients can have the procedure done in a surgical suite, and go home immediately afterwards.
What kind of anesthesia is used?
In almost all cases, procedures can be done under simple local anesthetic. General anesthesia has been used historically, but it is more likely to cause post-operative pain and cause general medical problems than local anesthesia, so is used less and less. Spinal anesthesia and I.V. sedation may also be used.
If you use local anesthesia, can I feel what's going on?
You'd feel touching and pressure, but no pain.
If you use local anesthesia can I see what's going on?
You can't see what's going on, as there are blinds covering the operative site. Most patients watch TV, listen to music, read a book or even sleep during the procedure. Obviously, this is a big difference with how this sort of surgery used to be done.
Can I walk after Tailor's bunion surgery?
In most cases, the patient may walk away from the procedure. The patient is not walking completely normally immediately post-operatively, of course, or certainly to the extent as the day before the surgery, but most patients are ambulatory.
However, there are still occasions where non-weight bearing is required after a procedure, so this decision is made on a case-by-case, foot-by-foot basis.
So how do I know what procedure is right for me?
Because of the number of variables in foot type and the number of procedures available from which to choose, the only way to assess what procedure you may need is to examine the foot and x-rays very carefully beforehand. Choosing the proper surgical procedure is a very in-depth process, and decisions are made on a careful, individual, patient-by-patient, foot-by-foot basis.
This is why it is recommended that patients considering this, or any, foot surgery--choose an experienced surgeon who specializes in foot surgery.