What is a Fifth Metatarsal Osteotomy for Bunionette?

A bunionette (also known as a tailor's bunion) is a painful bony prominence, or bump, on the outside of the fifth (little) toe. Over time, the bunionette may worsen as the fifth 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 fifth toe area. All bunionettes can cause pain and pressure on the outside of the foot, though often they do not cause symptoms.

An osteotomy is a surgically performed cut of the bone. A fifth metatarsal osteotomy refers to a cut in the head, neck, or shaft of the bone to make it straighter and the bony prominence smaller. This reduces rubbing on the outer side of the foot and decreases or eliminates the pain. 

Symptoms

Your foot and ankle orthopaedic surgeon may recommend surgery if your bunionette (bump) is painful, does not improve with non-surgical treatment, and prevents you from wearing comfortable shoes. Non-surgical treatment options include wearing wider shoes, shaving the callus on the outer side of the fifth metatarsal, padding the area, removing pressure from the bump by using a donut pad, or using a pre-made or custom orthotic device.

Surgery should never be chosen before non-surgical measures have been tried. Surgery should be avoided if you have an infection at the fifth toe or around the surgical site, or if your toe has poor circulation. Poor circulation can be caused by smoking and diabetes and can lead to problems with wound healing after surgery. A fifth metatarsal osteotomy is not needed if the bone is well-aligned. Surgery should not be considered for ease of shoe wear if you are not having pain.

Treatment

This is an outpatient procedure, meaning the patient can go home the same day as surgery. The bump in the bone is cut down and the fifth metatarsal is cut, repositioned, and fixed in position to corrects its deformity and decrease pain.

Specific Technique

The location where the bone is cut varies depending on the shape of the bone. This procedure often is done along with shaving the outer side of the bump itself. The far end of the bone is then shifted inward, and held in place using sutures, wires, screws, or screws and a plate.

Recovery

The recovery will depend on the specific surgical technique used. After surgery, the patient may not be allowed to bear weight for up to six weeks, which will require the use of crutches or a knee walker. For the first two weeks after surgery, a splint with a bandage is worn, and the foot cannot get wet. For several weeks after surgery, the patient may have to elevate his or her foot above chest level to decrease swelling. Swelling may last for several months after surgery.

After a couple of weeks, the stitches are removed. In the following few weeks, the patient wears a boot to protect the foot. After another few weeks, the patient progresses to weight bearing and possibly physical therapy. The boot may be removed several weeks after surgery.

Sometimes, a bunionette is fixed as the same time as a bunion (a bump at the big toe). In that case, the recovery is determined by the procedure on the bunion.

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.

Complications that may occur from a fifth metatarsal osteotomy include the bone taking a long time to heal or not healing at all. It is uncommon for the bunionette to come back.

 

Original article by Scott Ellis, MD
Last reviewed by Jeffrey Feinblatt, MD, 2018

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