Bunionette Deformity (also called a tailor’s bunion) is the bony prominence on the lateral side of the fifth metatarsal head of the foot.
Tailor’s bunion, referring to the position in which tailors would sit on the floor with their legs crossed, forcing the lateral border of the foot against the floor.
- More common in adolescents and adults.
- Women > Men
- Usually a bilateral deformity.
- Bunionette Deformity often is seen in splay foot combined with hallux valgus, or the head of the fifth metatarsal may be congenitally or traumatically enlarged.
- Also, the shaft may be angulated laterally, making the fifth metatarsal head more prominent.
- It may be caused by compression of forefoot (tight shoes).
- In case of inflammatory arthropathies.
Bunionette Deformity Radiology
Radiographic evaluation of this deformity should include standard weight-bearing views of the foot, including dorsoplantar, lateral, and oblique, should be obtained for measurement of the 4-5 intermetatarsal angle (4-5 IMA).
This angle is formed by two lines that bisect the fourth and fifth metatarsals:
- The normal angle is less than 6.5 to 8 degrees
- In symptomatic bunionette: the angle is 9.6 degrees.
Other angles that may be useful are:
- The lateral deviation angle: which is formed by a line from the center of the metatarsal head and neck to the metatarsal base and a line along the medial cortex of the fifth metatarsal (normal= 2.6 degrees; with bunionette = 8 degrees).
- The fifth metatarsophalangeal angle, which usually is more than 14 degrees in symptomatic patients.
MRI is indicated to rule out other pathology and clarify pathology of surrounding structures.
Classification of Bunionette Deformity
Bunionette Deformity is classified into three distinct types based on the anatomic location of the deformity along the fifth metatarsal:
- Type I deformity: distinguished by presence of an enlarged fifth metatarsal head, or a lateral exostosis.
- Type II deformity: demonstrates lateral bowing of fifth metatarsal diaphysis.
- Type III deformity: demonstrates an abnormally widened fourth-fifth metatarsal angle (an increased 4-5 IMA >8 degrees).
Type III is the most common deformity
Bunionette Deformity Symptoms
- Pain over lateral or plantar aspect of MTP joint, particularly with compressive shoewear.
- Constricting shoes are the main source of discomfort. With continuous pressure over this bony prominence, a bursa develops and enlarges because of chronic irritation.
- Ulceration may develop.
- An intractable keratosis may develop over a prominent bunionette because of shoe pressure. In diabetes, advanced Charcot-Marie-Tooth disease, or certain types of spinal dysraphism with poor sensibility, this complication can result in loss of the entire fifth ray or even the foot.
- A diffuse callus or localized intractable keratosis can develop beneath the plantar aspect of the fifth metatarsal head.
Bunionette Deformity Treatment
Conservative treatment is usually effective, it consists of:
- Shoewear modification
- Strategic padding
- Shaving the symptomatic callus.
- With plantar callus or associated pes planus, consider a metatarsal pad or custom orthotic device.
If surgical treatment becomes necessary, the choices are:
- Lateral metatarsal head condylectomy (in type I).
- Distal fifth metatarsal osteotomy (i.e., chevron; in type II).
- Oblique diaphyseal osteotomy (in type III).
- Consider metatarsal head resection for salvage.
Proximal osteotomy should be avoided owing to the tenuous blood supply at the proximal metadiaphyseal junction of the fifth metatarsal.
Questions for patients
How do you treat a Bunionette?
Bunionette can be treated by Shoewear modification and deformity padding in mild cases, or by surgical correction (bone osteotomy) in severe cases.
How do I get rid of a tailor’s bunion?
You can lessen the pain and prevent the deformity from developing by wearing a comfortable flexible shoes, and padding the bunion with silicone bunion pad. In severe deformity or those didn’t respond to conservative treatment, an orthopedic surgeon would perform a full assessment and guide you to corrective surgery.
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