What Is a Bunionette Deformity?

A bunionette (also known as a tailor's bunion) is a painful bony prominence, or bump, on the outside of the little (pinky) toe. Over time, the bunionette may worsen as the little toe moves inward and the fifth metatarsal (the bone connected to it) moves outward. Rubbing between the bump and tight shoes may also cause a callus to grow over the area. All bunionettes can cause pain and pressure on the outside of the foot, though often they do not cause symptoms.

Treatments

The initial treatment of a bunionette is non-surgical. This can include wearing shoes that are roomier with a wide toe box to avoid rubbing on the bony prominence. Padding the little toe using a toe sleeve may reduce discomfort as well.

If your bunionette is painful even after wearing wide, comfortable shoes, if you cannot wear comfortable shoes because of the size of your bunionette, or if you continue to have problems after non-surgical treatment, your foot and ankle orthopaedic surgeon may recommend surgery. The goals of this surgery are to remove the bony prominence and correct alignment to decrease pain. Surgery should be avoided if you have poor circulation or uncontrolled diabetes, if you are a chronic steroid user, or if you smoke cigarettes. These are risk factors for delayed healing of incision and bone.

Bunionette surgery is usually an outpatient surgery, meaning you can go home the same day as the surgery. It involves removing the bony prominence of the bunionette. In a larger bunionette that is causing an alignment problem, breaking the fifth metatarsal bone and restoring normal alignment may be necessary. Your foot and ankle orthopaedic surgeon will explain what kind of surgery is needed for you and why.

Specific Techniques

The type of surgery to correct the bunionette depends on the shape of the fifth metatarsal bone, type of bunionette, and patient's wishes. 

  • If you have a painful prominence without a bony growth, the surgery usually involves removing the painful soft tissue of the little toe. 
  • If you have a Type 1 bunionette, it means you have an enlarged bump at the outer end of the fifth metatarsal head (where the toe meets the foot). During surgery, this bony growth is removed. 
  • Sometimes the bony protuberance is so big that the bone of the fifth metatarsal needs an osteotomy, which means your surgeon will break the bone to realign it. The bone is cut and moved towards the fourth metatarsal to correct the alignment.    
  • If you have a curved shape to your little toe (Type 2 bunionette) or angle (Type 3 bunionette) between the fourth and fifth metatarsal, your surgeon will often do an osteotomy. This osteotomy is done to straighten out the fifth metatarsal. 
  • If a bunionette deformity is treated with an osteotomy, the bone may be held straight with a steel wire, screw, or plate and screws, depending on the surgeon's preference. 
Bunionette

Above: An X-ray image of a patient with a Type 1 bunionette

Below: An X-ray image of the bunionette after surgery. The patient was treated with an osteotomy, which was fixed with one screw.

Repaired bunionette after surgery

Recovery

After the surgery, patients may need to stay off their operated foot with no weight or heel weight bearing on it for a period of weeks. Patients will need to wear a post-surgical shoe or a short CAM boot on their foot to keep it protected after surgery. You may also need to use crutches or a walker depending on your activity level and pain. In severe deformities, some surgeons will place a short leg splint to better protect the surgical correction. The specific amount of time that your foot needs to be protected after surgery depends on the type of surgery and the surgeon's protocol. The operated foot will need to be elevated above the level of the heart as much as possible for at least the first few days. This will help to decrease swelling. 

Your stitches are usually taken out 2-3 weeks after surgery. You will be asked to not soak your foot or get the surgical area wet until your stitches are out.

Your foot and ankle orthopaedic surgeon may ask you to do knee and ankle exercises at home after surgery. This can help maintain your joint motion and flexibility. If your doctor thinks that you need physical therapy after the soft tissue and bone is healed, he or she will discuss that with you.

Swelling is the last thing to improve for most patients after bunionette surgery. It can take 6-12 months for your foot's swelling to completely improve after surgery.

Risks and Complications

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Potential complications after bunionette surgery are rare. Possible problems include bleeding from the wound, injured nerves around the little toe, poor wound healing or bone healing if an osteotomy is done, and the possibility of recurrence of the bunionette.

If my bunionette deformity is treated without surgery, can I ever wear high heels and pointed shoes?

Wear pointed-toe shoes as little as possible. This does not mean that you cannot ever wear these shoes, but you should limit the time wearing them in order to decrease pain and the chance that the bunionette will get worse.

If I'm treated with surgery, will the deformity come back?

Most bunionettes do not come back after being treated with the right type of surgery. The surgery should correct the underlying cause of the problem. However, wearing shoes that are too narrow can still cause irritation and inflammation at the operated little toe.

 

Original article by Umur Aydogan, MD
Contributors/Reviewers: Wen Chao, MD

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