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. You should avoid surgery 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 if you are not having pain.
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.
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.
The recovery will depend on the specific surgical technique used. After surgery, you 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, you may have to elevate your 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, you will wear a boot to protect the foot. After another few weeks, you can progress 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
Contributors/Reviewers: Jeffrey Feinblatt, MD
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