A tailor’s bunion, also known as a bunionette, occurs on the outside of the foot near the 5th toe (smallest toe). The deformity is much like a bunion, however its located on the outside of the foot instead. Most bunionette deformities consist of a bony component from a prominent metatarsal head, but many also involve soft tissue swelling or a bursal sac. Just like big toe bunions, they tend to be slow growing and develop over time from shoe wear and activity. The normal position of the 5th toe is often compromised by tight shoes/a narrow toebox, which causes a drift in the pinky toe toward the big toe. The 5th toe joint does not often have pain with motion like a bunion, but more so with pressure while walking.
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Symptoms
Painful bursa (small fluid filled) sacs often form on the outside of the bone in order to provide more padding in shoes. These bursa are often painful, swollen and red. Corns and calluses can also form on the outer aspect of the bone due to persistent rub in shoe gear. If pain continues, people often alter their gait in order to reduce pressure to the outside of their foot. This leads to difficulty in walking and compensation that can cause pain in other joints, such as the ankle or knee. Narrow or pointy-toed shoes often causes irritation to the outer skin overlying the bunionette bony prominence. In severe cases the skin can blister and form an underlying ulceration, which can become infected.
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Causes
Bunionettes are caused by footwear, external pressures (for example, tailors that sat cross-legged on a floor to work on shoes/clothing), and genetics. Footwear that restricts the front part of the foot, or high heels, tend to place more pressure on the area of the bony deformity. More women than men tend to have a bunionette deformity due to shoe characteristics. Lastly, patients with big toe bunion deformities often also experience bunionettes, due to lack of room in shoe toeboxes, and genetic anomalies, such as bowing of the long bones of the foot.
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Treatment
Treatment for a bunionette is almost always non-surgical and can be treated by a professional, such as a Chiropodist or Pedorthist. Treatments include proper footwear, with features such as a wider toe box and instep of the shoe, allowing for decreased pressures to the outside of the foot. There are silicone pads that can be worn to reduce the rub of shoes as well. Oftentimes sandals are preferred for patients to prevent rubbing in closed-in shoes. Semi-rigid orthotics often help with the foot alignment in order to decrease lateral pressures of the foot. Non-steroidal anti-inflammatory medications such as ibuprofen, naproxen or prescription medication may be necessary to reduce the inflammation around the 5th toe joint and reduce the size of any present bursa. Foot pain is not normal and we can help!
