The main thing to know about bunionette (also known as a Tailor’s Bunion) is that they’re not a bump or a growth. A bunionette can be caused by an angular deformity between the fifth metatarsal and the proximal phalanx, a bowed metatarsal, or an enlarged metatarsal head. Therefore, correction of a bunion is not removal or shaving of a bump. It’s a complex reconstructive surgery in which we change the shape of the foot. Many times, bunionettes are not treated appropriately. For this reason, some people associate the surgery with prolonged pain. In addition, many patients are dissatisfied with the cosmetic appearance and lack of pain relief from their improper surgeries. No bone should be removed in the treatment of a bunionette. The shape of the bones has to be changed, and the soft tissue has to be tightened.
There are two main causes of bunionettes: genetics and shoewear. Almost all shoes can cause the toe to be squeezed in a way that can cause a bunionette, but the more narrow or pointed the shoe, the worse the risk. Some people have an inherited tendency towards persistence of the deformity even with shoes off.
Sometimes a pre-existing bunionette will become more painful with certain shoes or with trauma. Often, these will resolve with time.
A set of high-quality weight-bearing (standing) x-rays are required for diagnosis, as well as a thorough physical examination. Specific x-rays will be taken in my office to ensure the highest quality of x-rays.
Anti-inflammatories such as traditional NSAIDs (ibuprofen or naproxen) can allevaiate pain when taken around-the-clock for two weeks. Dietary supplements with anti-inflammatory properties include turmeric and arnica. Ice is a potent anti-inflammatory and should be placed at the painful site at minimum once or twice a day. The skin must always be protected by a tea towel, and icing should not exceed 15 minutes per hour.
Shoewear modification to avoid high heels and narrow, pointed toes that predispose to bunionette formation and pain. Shoes with a soft upper are preferred. Shoes can be taken to a cobbler to be stretched around the bunionette.
Orthotics and braces do not help with bunionettes. There are no devices that will reverse the deformity.
Surgery is necessary when the pain is not able to be treated via shoewear modification. This requires reshaping the metatarsal. This is high risk for failure to heal because of poor blood supply to this area. Because bunionettes will recur with shoes that recreate the deformity, the rehabilitation from this surgery is prolonged open-toe shoewear followed by allowance of tennis shoes no sooner than four months postoperatively. No weight-bearing is allowed for at least six weeks after surgery.
Injections do not help with bunionette. The issue is generally pressure due to shoe wear, which is not aided by an injection.
Bunionette surgery is a complex reconstructive surgery. Beware of promises of pain-free return to normal activity in the short term. There is no way to make soft tissue and bone heal faster. As is often the case, the best things take a bit of effort and time, and are generally worth the investment.
Bunionette surgery will not change your shoe size. It will make you more comfortable in your actual shoe size.
Bunionette surgery is not meant fore purely cosmetic purposes. It is possible to convert a pain-free bunionette to a painful but beautiful foot. For this reason, it is only medically indicated to operate on bunionettes that cause discomfort.
See a Board Certified Orthopaedic Surgeon with accredited fellowship training in Foot and Ankle surgery about your bunion.
Be prepared for a new set of x-rays in office. Not all x-rays are the same.
Be prepared for a postoperative protocol that allows for downtime as well as time in a medical shoe. Normal shoewear is not immediate and can lead to recurrence.