Bunionette (Tailor's Bunion)

A bunionette, or tailor's bunion, is a bony lump on the outside of the foot at the base of the little toe. It forms where the head of the fifth metatarsal bone sticks out. Wider shoes and padding usually ease it. If pain continues, surgery to realign the bone (an osteotomy) gives a narrower foot.

The lump comes from an enlargement of the outer part of the fifth metatarsal joint, sometimes with the bone bowing or angling outwards. Shoes rub on the prominence, and the skin and the small fluid sac (bursa) over it can thicken and become inflamed. The condition is more common in women than men.

What causes a bunionette?

• Prolonged abnormal pressure and rubbing on the little toe joint
• Shoes that are too tight or narrow, squeezing the toes together
• High-heeled or pointed footwear
• Genetic predisposition: it can run in families
• An associated bunion of the big toe

The shape of the foot matters as much as footwear. The fifth metatarsal may have a broad head, may bow outwards, or may sit at a wider angle to the fourth metatarsal. A flat foot can also push the outer border of the forefoot outwards.

What are the symptoms?

• A visible bony lump on the outer side of the foot
• Redness, swelling and tenderness over the prominence
• Pain when wearing shoes
• Callus (hard skin) over the bump
• Difficulty finding comfortable footwear

Some people also develop hard skin under the fifth metatarsal head on the sole of the foot. A case-control study in the International Journal of Environmental Research and Public Health (Mazoteras-Pardo and colleagues) found that people with the type of tailor's bunion caused by a widened angle between the fourth and fifth metatarsals reported worse foot pain, foot function and footwear scores.

Non-surgical treatment

Treatment starts with reducing pressure on the lump:

• Wider, roomier footwear, so the outside of the foot is not squeezed
• Bunionette pads to cushion the prominence and reduce friction

These simple measures are always the first step and are often successful, because most people only have pain in shoes. Shoes can also be stretched where they press.

When is surgery recommended?

If conservative measures fail, surgical correction may be recommended. In Mr Hester's experience, the best results come from breaking and realigning (osteotomy) the fifth metatarsal bone, rather than simply shaving off the bump. Realigning the bone gives a narrower foot that rubs less on footwear and minimises recurrence. A small screw holds the bone in its new position while it heals.

This approach is consistent with the published evidence:

• Shaving the bone alone (exostectomy) is linked with recurrence of the deformity when an osteotomy was actually needed.
• A meta-analysis of 28 studies in the Journal of Foot & Ankle Surgery (Martijn and colleagues) found that all types of fifth metatarsal osteotomy significantly corrected the angle of the bone, with an overall mean success rate of 93%.

What is recovery like?

The bone typically heals over 4–5 weeks, during which time the foot is protected in a surgical sandal. Swelling around the outside of the foot can take longer to settle, so wide, comfortable shoes are helpful for some weeks after the sandal comes off.

How Mr Hester can help

Mr Hester is a dual fellowship-trained foot and ankle surgeon (FRCS Tr&Orth), trained at Guy's and St Thomas' and in Toronto and Calgary, and a member of BOFAS and EFAS. He sees patients privately at The London Clinic, Cromwell Hospital, King Edward VII's Hospital and HCA The Shard. His NHS practice is at King's College Hospital.

Insured patients need a GP referral and an authorisation code from their insurer. Self-pay patients are welcome. To book, call 020 7046 8004.

Frequently Asked Questions

Sources

1. Martijn HA, Sierevelt IN, Wassink S, Nolte PA. Fifth Metatarsal Osteotomies for Treatment of Bunionette Deformity: A Meta-Analysis of Angle Correction and Clinical Condition. J Foot Ankle Surg. 2018;57(2):364–370. PMID: 29268897. https://pubmed.ncbi.nlm.nih.gov/29268897/
2. Mazoteras-Pardo V, et al. Degree of Impact of Tailor's Bunion on Quality of Life: A Case-Control Study. Int J Environ Res Public Health. 2021;18(2):736. PMID: 33467061. https://pubmed.ncbi.nlm.nih.gov/33467061/
3. Bunions. NHS. https://www.nhs.uk/conditions/bunions/