Tailor's bunion or bunionette

Definition

Lateral protrusion of the basal joint of the 5th toe with or without a bursa. The deformity causes pain and difficulties complying with shoe-wear.


Causes
Often seen in broad flat feet, sometimes in conjunction with a hallux valgus but also as a local deformity. If the base of the 5 th toe is diverging laterally upon stance it is likely this deformity can occur. There are several types of deformity which inevidently can lead to variants of  plausible surgical management.


Symptoms
Pain locally laterally and difficulties to fit shoes or sport equipment such as skates or likewise. Sometimes red swollen and possibly with ulcerations or small wounds with possible secondary infection


Diagnosis
It is obvious upon clinical examination. If surgical management is indicated a weight bearing X-ray is recommended to define the pathology.


Medical treatment

As the problem is a combination of uncomfortable pressure and friction laterally  a modified shoewear with a broad stable shoe is recommended. Sometimes a custom-made insole with some lateral elevation might help in relieving the pressure.


Surgical treatment

Whenever medical therapy fails there is the option for surgery that in this condition usually reveals a success rate of about 90 % excellent to good results.

The main treatments that are recommended are a variety of realigning bone procedures ( osteotomies). These should be adapted to the pathology at hand which is at the surgeon’s convenience to counsel.