• Dr. Jennifer Nicole Falk

Tailor’s Bunion: The Other Bunion


BACKGROUND:

The term “tailor’s bunion” (aka bunionette) dates back to the 19th century when tailors would sit cross-legged, putting pressure along the lateral sides of their feet, causing irritation, callus formation, and pain to the 5th metatarsal head (1). Today, a tailor’s bunion is more commonly considered a structural or biomechanical deformity (1). It is similar to the bunion along the inside of the foot, but this one occurs on the other side, around the 5th metatarsal head and its associated toe joint.


CAUSES:


There are several potential causes for a painful tailor’s bunion. Tight shoe gear or any sort of pressure to the area can cause irritation to the 5th metatarsal head, especially in the presence of a large metatarsal head. Lateral bowing of the 5th metatarsal and increased splay between the 4th and 5th metatarsals can also cause a tailor’s bunion deformity (1,2).


SYMPTOMS:

Pain, if present, is around the 5th metatarsal head and is usually exacerbated with shoe gear. The irritation of shoe gear against the bunionette can also lead to redness and swelling.


DIAGNOSIS:

Clinical exam:

A bony prominence is found around the 5th metatarsal head, and there may be pain with palpation of the bump. As a result of shoe irritation, some redness and swelling could be localized around the bony bump. In certain situations, a callus or even a bursa (a fluid-filled sac inside the foot) is also present. Deformity of the 5th toe is also not uncommon in the presence of a Tailor’s bunion (1,2).

Imaging:

X-rays can be used to further examine the 5th metatarsal and bunionette site. Looking at the 5th metatarsal head, the head can be evaluated for size, shape, and presence of any cysts. Certain angles can also be measured, which help determine the where the deformity is originating, how severe it is, as well as help with surgical planning.


TREATMENT:


The only way to correct the deformity is with surgery. However, it is important to try conservative care first because there are always risks associated with surgery. Conservative treatment is aimed at trying to slow down the progression of any associated deformity and/or to help improve the symptoms.


Conservative Treatment Options:

Callus debridement

Trimming of any calluses should be done by a healthcare professional. At home, for maintenance, routine use of a pumice stone or emory board can be tried.


Shoe gear

Shoes with a wider toe box can help accommodate for the increased width of the foot in the presence of the tailor’s bunion.


Orthotics

These are devices that go into shoes to help cushion, support, and control abnormal motion(s) of the feet, which may help slow down the progression of the tailor's bunion deformity. They can be purchased off-the-shelf or be custom-made.


Pads

Pads can be used in two ways. They can either be used to cushion the area or to offload the area (e.g. donut pad). Over-the-counter products can be purchased to protect the area while wearing shoes.


Anti-inflammatory medications

Over-the-counter pain medications can help with acute exacerbations of pain around the bunion site, but they should not be used chronically.


Surgical Treatment Options:

If conservative treatments fail, surgery can be considered. The goal with surgery is to alleviate pain and/or improve the anatomic alignment. Therefore, options include resection of the bony bump, 5th metatarsal osteotomies, and even resection of the entire 5th metatarsal head.


The treatment of choice is dependent on several factors, including the age of the patient, their bone density and/or the presence of any bone cysts in the head of the 5th metatarsal, and the severity of the deformity. The after-surgery protocol is determined by the surgery performed.



DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.


References:

1. Ajis, A., Koti, M., & Maffulli, N. (2005). Tailor’s bunion: a review. The Journal of foot and ankle surgery44(3), 236-245.

2. Thomas, J. L., Blitch, E. L., Chaney, D. M., Dinucci, K. A., Eickmeier, K., Rubin, L. G., ... & Vanore, J. V. (2009). Diagnosis and treatment of forefoot disorders. Section 4. Tailor's bunion. The Journal of Foot and Ankle Surgery48(2), 257-263.


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