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What is Bunionette (Tailor’s Bunion)?

Bunionette, also called Tailor’s bunion, is a bony lump formed along the outside of the little toe at the base. It occurs when the very bottom bone (fifth metatarsal bone) of the little toe enlarges or shifts outward. Sometimes, it can be a bony spur (an outgrowth of bone) on the side of the fifth metatarsal bone head. 

Causes of Bunionette (Tailor’s Bunion)

There are several factors, both extrinsic or intrinsic, that can cause a bunionette, including:

  • Improper footwear, such as poor or tight fitting and high-heeled shoes (extrinsic). 
  • Abnormal or faulty little toe due to congenital factors (intrinsic).
  • Below normal position of the fifth metatarsal bone. 
  • Inverted foot (the foot that leans to the outside).
  • Loose ligaments in the foot.
  • Tight calf muscles.

Tailor's Bunion occurs more often in women than in men. 

Signs and Symptoms of a Bunionette

Bunionettes may start out small but can grow larger with time. Swelling with redness and pain at the site of the lump is the main symptom of the condition. The symptoms are felt more when the affected part rubs against a shoe or anything that it comes into contact. 

What if the Condition is Left Untreated?

If Tailor’s Bunion is left untreated, the lump can increase in size over time and cause more pain making walking extremely difficult. Chronic rubbing of the lump against footwear can lead to redness in the skin and result in irritation or even skin callus (thickened skin). 

Diagnosis of a Bunionette (Tailor’s Bunion)

Your doctor can diagnose a Tailor’s Bunion just by looking at the foot as the lump is visually apparent. However, an X-ray may be needed to determine the exact cause and extent of the deformity.

Treatment of a Bunionette (Tailor’s Bunion)

Typically, non-surgical options are the first choice of treatment for a Tailor’s bunion. The surgeon may try out any or a combination of the following to treat the condition.

  • Wear a shoe with a wider toe box and avoid narrow and pointed shoes with high heels.
  • Apply silicone padding and/or cushioning over the Tailor’s Bunion to relieve pain.
  • Wrap ice dressings to the affected area for 5 to 10 minutes up to 3 times per day.
  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain.
  • Use orthotic devices in combination with calf stretches two times per day. 

Additionally, if the condition does not improve, the doctor may consider corticosteroid injections to the little toe joint to reduce swelling and inflammation. All of these options, however, can help relieve the pain but cannot get rid of the lump. 

If the pain and swelling do not go away, surgery can be considered. Bunionette surgery is normally performed as an outpatient procedure. Under anesthesia, the surgeon may shave off the bony tissue that is sticking out. A part of the bone in the little toe may also be removed (osteotomy). This is done to realign the fifth metatarsal bone and straighten out the toe so that it does not point outwards. The repositioned bone will be held in place with a screw or a plate, or a piece of steel wire.

After the surgery, your surgeon may recommend physical therapy and necessary rehabilitation protocols as a part of the recovery process. The length of recovery period may be quite long (three months to a year) and may vary depending on the procedure, activity level, and other factors.

Occasionally, a Tailor’s Bunion can recur after surgery. Often, this can be attributed to the use of narrow shoes after surgery, which makes the bunionette more likely to come back.