Bunionette Pain Relief: How To Treat Painful Little Toe

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's like the much more well-known bunion, which is a bony protrusion at the base of the big toe, except on the other side. It's called tailor's bunion because the cross-legged sitting position once associated with tailors increases the risk of developing this deformity.

Bunionettes usually start as a painless protuberance — and in most cases, it'll be no more than a minor nuisance that might make choosing shoes a little harder.

In some patients, hypertrophic keratosis (a callus) occurs. The bone deformity sometimes causes pain when combined with inflammation in the area of the joint. Have in mind that this condition is painless in a lot of cases, and it doesn’t require clinical attention then. Bunionettes that don't cause pain or discomfort might not require treatment, but patients should still look into ways to prevent the further development of the condition [1].

Although bunionettes often initially occur on just one foot, the other foot will often show signs of either a bunionette or bunion and both will require treatment to resolve the problem. One study revealed that most patients who suffer from a bunionette have other foot deformities as well, making it essential to examine the entire foot [2].

Foot pain or discomfort can influence the body's balance, too; patients shift their body weight to the other leg to minimize discomfort, which then 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].

How To Treat A Bunionette (Painful Little Toe)?

If you suffer from a bunionette (as opposed to merely having one), pain relief can be accomplished using both nonsurgical and surgical treatments. Nonsurgical treatment for bunionettes involves medical wearables, medication, or both. The goal of treatment is to resolve the pain and slow down the further 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, it's best to avoid it as even routine operations carry some risks.

The majority of bunionette 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 for bunionette or tailor's bunion comes in a few different forms.

Adequate shoes

Your 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 in which people do not wear shoes (as much), 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. People who have bunionettes should place a pad in such a way that the bone deformity fits the hole perfectly. The pads may help relieve the pain associated with tailor's bunions, since it is pressure of the shoes on the bone protuberance that causes pain. Quite often, padding the bunionette is effective in managing the pain associated with the bunionette [8].

Using custom-made inserts for your shoes

If the regular commercially-available bunionette pads prove to be ineffective, custom-made (and expensive) orthotics may be needed. [8] Though they may seem like a heavy investment, such inserts are made especially for you and will serve your needs well.

Medicines

Although doctors should not recommend NSAIDs such as sspirin or ibuprofen as a routine management method for pain associated with a bunionette, these medications can relieve the pain in cases of particularly unpleasant relapses. Other than NSAIDs, steroid injections may be used to manage the pain. The doctor administers the steroids in the area of the bunionette and surrounding ligaments.

Surgical Bunionette Treatment

Your doctor may recommend surgical treatment for your bunionette if the pain persists in spite of efforts to relieve it with medical wearables and adjustments of your shoes, and the discomfort is having a significant negative impact on your life.

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 (meaning bunionettes occur 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 After Surgical Bunionette Correction?

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

Boesch technique

The Boesch technique is very commonly used to correct a bunionette, and probably the most popular method across the globe 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 in the initial days after your bunionette surgery. 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 it to the area where you had the surgery. Painkillers may be needed, and if you do use them, only do so as instructed. Avoid soaking the surgical area in water, since the risk of infection is increased that way.

Week 2-3.

Rest and elevate the foot you had surgery on whenever you can. Follow the rehabilitation plan, do your exercises. You can swim and bathe again. Increase your level of activity carefully and gradually. If the activity causes pain, you should stop it. Short distance walks are allowed and encouraged. 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 after your bunionette surgery, you should be able to go back to work (if your job requires using your foot a lot) and wear regular shoes again. However, you will still need to perform rehabilitation exercises. At this time, your life will go back to normal — except now hopefully without pain — although some check-ups may still 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.