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Bunionette Deformity Correction

​What is a bunionette?

A bunionette deformity is an abnormal bony protuberance, or bump, on the outer (lateral) side of the fifth toe or metatarsophalangeal joint (MTPJ). This problem can start out as small and painless, but then become larger and more painful over time. When bunionettes become larger, it is usually because of growth of the protuberance, a curved shape to the fifth MTPJ, or both. The condition is sometimes called a tailor’s bunion.

What are the goals of bunionette treatment?

The first way that patients are treated for their bunionette is through nonsurgical means. This can include wearing different shoes that are roomier, padding the fifth toe, and using special or custom-made inserts in the shoe. All of these are designed to reduce the discomfort over the prominent fifth toe or MTPJ.

If the bunionette’s symptoms does not improve with nonsurgical treatments, surgery may be needed. The goal of surgery is to decrease the fifth toe’s protuberance and deformity and to reduce pain.

What signs indicate surgery might be needed?

If you have pain at your bunionette, if you cannot wear comfortable shoes because of the size of your bunionette, or if you continue to have problems after receiving nonsurgical treatment, surgery may be required.

When should I avoid surgery?

Surgically treating a bunionette deformity is not advisable if you suffer from an infection at the fifth toe or bunionette deformity, or if you have poor circulation in your foot. Poor circulation may cause problems with the bone and/or wound healing after the surgery.

General Details of Procedure

Most often, bunionette surgery is an outpatient surgery. At the very least, the surgery involves removing the protruding soft tissue and bone of the bunionette. Some patients may also need a cut in the bones (osteotomy) of the fifth toe to straighten it out when it is curved. Your surgeon will advise you on the surgery that is needed for you and why.

After surgery, patients will need to stay off of their operated foot without putting weight on it for a couple of weeks. Patients may also need to wear a protective device on their foot to keep it protected after surgery.
These devices can include a splint made of plaster, a boot around the leg or a hard-soled surgical shoe. The length of time a patient’s foot is kept protected after surgery will depend on the extend of the surgery.

Specific Techniques

The most common reason that causes bunionettes to develop or become painful is wearing shoes that are too narrow or tight in the toes (toe box). To fully decrease the pain, irritation and swelling, either before or after surgery, roomy, comfortable shoes are recommended.

If surgery is needed, several methods are available. The actual type of surgery to be performed depends on the shape of the fifth toe bones, type of bunionette and patients’ choice. 

  • If patients have a painful fifth toe protuberance without a bony growth, the surgery usually involves the removal of the painful soft tissue at the fifth toe. Specifically, the excess skin and the joint’s inflamed soft tissue or bursa is removed.

  • Patients with a bony protuberance at the fifth MTPJ will have this bony growth removed. Some surgeons call this a bunionectomy.

  • Sometimes the bony protuberance is so big that the bones of the fifth toe need an osteotomy. With the bone cut, it is then moved inward to decrease its size.   

  • If patients have a curved shape to their fifth toe or angle between the fourth and fifth toes, then an osteotomy is recommended. This osteotomy is done to straighten out the fifth toe.

  • If a bunionette deformity is treated with an osteotomy, the bone is often kept straight with a steel wire, screw, or plate and screws, depending on the surgeon’s recommendations.  

What happens after surgery?

Full recovery after treatment of bunionettes is different based on the treatment. A nonsurgical treatment of between three and six months should be considered as many symptoms have been seen to improve this way.

Most surgical treatments need some recovery time with the use of foot protection in the form of surgical shoe, boot or splint. This is used in the time frame of between three and twelve weeks. The specific time for recovery after surgery depends on the type of surgery performed.

You will be asked to elevate your foot above your chest level for the first weeks after surgery. You may also be asked to use crutches or a walker depending on your level of activity.

Your stitches are taken out two to three weeks after surgery. You will be advised not to soak your foot or get the surgical area wet until your stitches are removed.

Your doctor may require you to perform some knee and ankle exercises at home after surgery. This can assist to improve and maintain your joint motion and flexibility.

Potential Complications

There are several complications that relate to surgery in general. These include the risks that are 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 fifth toe, poor wound healing or bone healing if an osteotomy is done, and the recurrence of the bunionette.

 

Frequently Asked Questions

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

Wear narrow-toe shoes as little as possible. This does not mean that you cannot ever wear these shoes. It means that the time you wear these shoes should be limited in order to decrease the pain and reduce the chance of the bunionette from getting worse.

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

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

What causes a bunionette or Tailor’s Bunion? 

Bunionettes can develop for several reasons with a biomechanical abnormality (improper function of the foot) being the most common cause.  In an unstable flat foot, for example, a muscular imbalance often brings about the development of bunionettes.
Bunionettes tend to run in families, and most podiatrists believe that genetic factors play a role in predisposing some people to develop bunions. 

Poor shoes like high heels and pointed toe boxes exacerbate the condition by speeding up the development of bunionettes, and by making them more painful. This is at least one of the reasons bunionettes are much more common in women than men.

What symptoms do people with this condition have?

Bunions often start out as a mild bump on the side of the foot, or an inward bending of the small toe. Bunionettes at this stage are usually only a concern of appearance at this stage, and don’t hurt much.

Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the fifth toe gradually pull it farther and farther towards the fourth toe.  Sometimes patients will find their fourth and fifth toes begin to press together too much, and they’ll often get a painful corn between those toes.  

Bump pain at the site of the bony enlargement on the side of the foot may develop or a painful bursa may develop at that area. 

Over a period of time, with the fifth toe held in a crooked position, arthritis may develop in the fifth toe joint.  

Pain associated with this condition may change the way a person walks, which may cause secondary pain in the legs, knee, hip, and lower back. 

How are bunionettes treated?

Bunionettes are progressive problems, meaning they tend to worsen over time.  Sometimes severe bunionettes don’t hurt much, and sometimes relatively modest-looking bunionettes hurts more.  Thus, treatment varies depending upon the person’s symptoms.

You can often reduce the discomfort by wearing proper shoes. Proper padding and various over-the-counter and custom-made orthoses and latex accommodative shields can also alleviate bunionette pain.  Such devices don’t correct bunionettes, but if properly designed and made, they can alleviate pain and/or slow its growth.

Often, when conservative measures fail to alleviate pain associated with the bunion, when you start to limit the types of activities you perform, when it’s difficult to find comfortable shoes, or when arthritis changes how you walk, surgery may be the necessary option.

What does bunionette surgery involve? 

There are various procedures designed to address bunionette deformities, with each having different indications.  For example, some procedures simply address an enlarged bony bump.  Some address the issue of having crooked fifth toe.  Some may be directed at a painful bursa.  Other procedures address the misaligned bone behind the fifth toe. In order to slow the return of the bunionette deformity, most procedures aim to address each of these conditions.   

If the bones are cut and realigned, how do you hold them together?   

Sometimes a screw is placed in the foot to hold a bone in a corrected position. Other times a pin, wire or even a plate is used. There are even absorbable pins and screws, which are used for some patients. There may be occasions when no materials are required to hold the bone together at all.

Is a cast used?

Sometimes a cast is used, particularly when certain unstable bone cuts are done. However, surgical procedures have evolved over the years in such a way that casts are used very much less frequently as compared to the past.  

Do patients need to be hospitalized?

In the past, patients are required to be hospitalized. However, now patients can have the procedure done in a surgical suite, and go home immediately afterwards.

What kind of anesthesia is used?

In almost all cases, procedures can be done under local anesthetic. General anesthesia has been used in the past, but it is more likely to cause post-operative pain and cause general medical problems as compared to local anesthesia. Spinal anesthesia and I.V. sedation may also be used.

Can I walk after Tailor’s bunion surgery? 

In most cases, the patient may walk away from the procedure.  The patient may not walk completely normal immediately after the operation, but most patients are ambulatory.  

However, there are still occasions where non-weight bearing is required after a procedure, so this decision is made on a case-by-case basis. 

So how do I know what procedure is right for me? 

As there are a number of variables in foot type and the various procedures available, the only way to assess what procedure you may need is to examine the foot and x-rays very carefully beforehand. Choosing the proper surgical procedure is a very in-depth process, and decisions are made on a patient-by-patient basis.  

This is why it is recommended that patients choose an experienced surgeon who specializes in foot surgery.    

Anatomy

Where does a bunionette develop?

A bunionette occurs over the area of the foot where the small toe connects to the foot. This area is called themetatarsophalangeal 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.

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