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Bunionette (Tailor’s bunion) is a bony bump at the base of the fifth toe (little toe). In most cases it is asymptomatic, however, it can cause severe pain and discomfort. There is a number of different non-surgical and surgical treatment methods.

A bunionette, also known as a Tailor’s bunion, is a bony bump on the outer side of the foot at the base of the fifth toe (little toe). It usually starts as a painless protuberance and remains like that in most cases. In some patients, hypertrophic keratosis (a callus) occurs. Bone deformity combined with an inflammatory response in the area of the joint sometimes causes pain. Have in mind that his condition is painless in a lot of cases, and it doesn’t require clinical attention then. In such cases, prevention of the further development of the condition is the goal of treatment [1].

Although this condition often initially occurs on one side, the other foot will often show signs of a bunionette/bunion and the treatment of both is needed to resolve the problem. A study revealed that most patients who suffer from a bunionette have other foot deformities, making it essential to examine the entire foot [2]. Foot pain or discomfort can influence the body balance; patients shift the body weight to the other leg, which affects the bone structures of the legs and spinal column, causing lower back pain in some patients. An extensive study discovered that Caucasian men and women are five times more likely to have Tailor’s bunions [3].

Halux vagus (HV) is a more common condition than Tailor’s toe, but in patients with HV, Tailor’s toe is often overlooked [4]. If you already have HV, have in mind that you may have an issue with bunionettes too.

How To Treat A Bunionette (Painful Little Toe)?

If you suffer from a bunionette, pain relief can be accomplished using nonsurgical and surgical treatments. Nonsurgical treatment involves medical wearables and/or medication. The goal of treatment is to resolve the pain and slow down the development of the deformity. In some cases, the patient will need surgery to correct the deformity.

Nonsurgical Bunionette Treatment

The first step for bunionette pain relief is nonsurgical treatment. Some patients insist on surgery to redress the defect, which can be aesthetically unpleasant. The doctor cannot repair the defect without surgery, and if there are no indications for surgery, one should avoid it. The majority of patients are elderly, and prone to complications because of their age and possible comorbidities. Most patients have good results when using appropriate shoes and paddings [5]. Nonsurgical treatment includes:

  • Adequate shoes

Shoe shape should be similar to the shape of your foot. Picking shoes with a wider and deeper toe box should relieve pressure on the bunionette. Shoes are recognized to be the leading risk factor for foot deformities (including bunionettes), and in societies that do not wear shoes, foot deformities are quite uncommon [6]. Studying forces under the foot while walking showed that there is a significant difference between different styles of footwear. The smallest forces were observed in plaster cast shoes and to a lesser extent, Plastazote insoles [7].

  • Padding the bunionette

Pads look like little donuts; they are round with a hole in the middle. A patient should place a pad so that the bone deformity fits the hole. The pads may help relieve the pain since it is pressure of the shoes on the bone protuberance that causes pain. Quite often, padding the bunionette is effective in treating the bunionette [8].

  • Using custom-made inserts for the shoe

If the pads prove to be ineffective, custom-made (and expensive) orthotics may be needed. [8]

  • Medicines

Although doctors should not recommend NSAID (Aspirin, Ibuprofen, etc.) for permanent treatment of a bunionette, these medications can relieve the pain in cases of particularly unpleasant relapses. Other than NSAIDs, steroid injections may be used. The doctor administers the steroids in the area of the bunionette and surrounding ligaments.

Surgical Bunionette Treatment

Your doctor will indicate surgical treatment if the pain persists in spite of efforts to relieve it with medical wearables and adjustments of your shoes. There are several surgical approaches to the treatment of this condition, but all of them have the same goal — pain relief and the correction of the deformity. If the condition is bilateral (occurring on both feet), two-step surgery is performed (the deformity is first corrected on one foot, and after the recovery period, the doctor will perform surgery on your other foot).

Surgery involves:

  • Removing the bone deformity. The surgeon uses a small chisel and cuts off the deformity.  Osteotomy realigns the pressure in the area of the bunionette and this resolves the irritation and inflammation of the surrounding tissue, thus relieving the pain. Although most patients report complete recovery and the absence of pain. In less than 10 percent of patients, the pain will not completely resolve.
  • Realignment of the fifth metatarsal bone. Realignment is done through a procedure called osteotomy. In order to realign the bone, reconstruct its physiological shape of the foot, and prevent relapse of the bunionette, the bone is cut in two pieces and realigned with temporary metal pins. After the bone heals, the pins are removed.
  • Soft tissue repair. Painful calluses and the soft tissue that grows due to chronic inflammation in the area of the bunionette are surgically removed.

What To Expect Afte Surgical Bunionette Correction?

There are a number of different surgical approaches in correcting a bunionette. Currently, there is no golden standard for surgical treatment of a Tailor’s bunion [9].

Depending on the difficulty of the case, doctors choose what technique to use. In most cases, minimally invasive approaches are enough to treat the condition, but if there is a severe deformity of the foot, more extensive procedures are performed.

  • Boesch technique

The Boesch technique is very common, probably the most popular method today. It is minimally invasive, performed under local anesthesia, and causes minimal bone, and soft tissue trauma. Eighty-six percent of patients are free of pain at their final follow-up. Radiographic findings after surgery are described as excellent to good. [10]

Recovery Timetable After Bunionette Surgery

  • Week 1.

Your doctor will advise rest and foot elevation. If you experience pain and swelling, you should apply ice. Keep in mind that you should never apply ice directly to the skin because of the possibility of frost bite. Instead, put ice in a plastic bag, wrap it in a towel, and then apply. Painkillers may be needed. Avoid soaking the scar area in water, since the risk of infection is increased that way.

  • Week 2-3.

Rest and elevate the foot whenever you can. Follow the rehabilitation plan, do your exercises. You can swim and bathe again. Increase the level of activity carefully. If the activity causes pain, you should stop it. Short distance walks are allowed. In this period, your doctor will remove the stitches.

  • Week 4.

You can drive again since you can perform an emergency stop without discomfort.

  • Week 6.

By week 6, you should be able to go back to work and wear regular shoes again. However, you will still need to perform rehabilitation exercises. At this time you will go back to normal, although some check-up may be needed.

It takes one year for the bone to fully remodel after your osteotomy. Although you will go back to normal completely in the second month after the intervention, have in mind that your foot needs a year before retrieving its physiological strength. 

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