Introduction

A bunionette is similar to a bunion on the inside of the foot, but it develops on the outside. It is sometimes referred to as a tailor's bunion because tailors once sat cross-legged all day with the outside edge of their feet rubbing on the ground. This produced a pressure area and callus at the bottom of the fifth toe.

A bunionette occurs over the area of the foot where the small toe connects to the foot. This area is called the metatarsal phalangeal joint, or MTP joint. The metatarsals are the long bones of the foot. The phalanges are the small bones in each toe. The big toe has two phalanges and the other toes have three phalanges each.

Causes

A bunionette is most likely caused by an abnormal bump over the end of the fifth metatarsal (the "metatarsal head") rubbing on shoes that are too narrow. Some people's feet widen as they grow older. This can cause a bunion on one side of the foot and a bunionette on the other. If they continue to wear shoes that are too narrow, the constant pressure produces a callus and a thickening of the tissues over the bump.

Skin responds to constant rubbing and pressure by forming a callous. The soft tissues underneath the skin respond to the constant pressure and rubbing by growing thicker. Both the thick callus and the thick soft tissues under it are irritated and painful. The answer to decreasing the pain is to remove the pressure. The pressure can be reduced from the outside by changing the pressure from the shoes. The pressure can be reduced from the inside by surgically removing any bony prominence.

Symptoms

The symptoms of a bunionette include pain and difficulty buying shoes that will not cause pain around the deformity. The swelling in the area causes a visible bump that some people find unsightly.

Diagnosis

The diagnosis of a bunionette is usually obvious on physical examination. X-rays may help to see if the bones of the foot have spread and will help your doctor decide what needs to be done if surgery is necessary later.

Treatment

Conservative Treatment

Treatment initially is directed at obtaining properly sized shoes accommodating the width of the foot. Pads over the area of the bunionette may help relieve some of the pressure and reduce pain. These pads are usually sold in drug and grocery stores. They are small and round with a hole in the middle.

Surgery

If conservative treatments fail, surgery may be recommended to reduce the deformity. Surgery usually involves removing the prominence of bone underneath the bunion to relieve pressure. Surgery may also be done to realign the fifth metatarsal if the foot has splayed.

To remove the prominence, the surgeon makes a small incision in the skin over the bump. The bump is then removed with a small chisel, and the bone edges are smoothed. Once enough bone has been removed, the skin is closed with small stitches.

If your doctor decides that the angle of the metatarsal is too great, the fifth metatarsal bone may be cut and realigned. This is called an osteotomy. Once the surgeon has performed the osteotomy, the bones are realigned and held in position with metal pins. The metal pins remain in place while the bones heal.

Rehabilitation

After surgery, you will usually be fitted with a post-op shoe. This shoe has a stiff, wooden sole that protects the toes by keeping the foot from bending. Any pins are usually removed after the bone begins to mend (usually three or four weeks). You will probably need crutches briefly, and a therapist may be consulted to show you how to use your crutches.

You will probably wear a bandage or dressing for about a week following the procedure. The stitches will probably be removed ten to fourteen days following the procedure. If your surgeon chooses to use dissolvable stitches, those will not need to be removed.

During your follow-up visits, X-rays will probably be taken so that the surgeon can follow the healing of the bones and determine how much correction has been achieved.