What is a Tailor’s Bunion?
A Tailor’s Bunion (or bunionette) is a deformity involving the 5th long bone (metatarsal) and its relationship with the 4th long bone. There is a shift of the bones into improper positions leading to pain and loss of function. The players involved in a Tailor’s bunion are: the 5th toe and the 5th metatarsal.
Over time a tailor’s bunion forms when there is a shift or bend the 5th metatarsal away from the 4th metatarsal and away from the rest of the foot (lateral). At the same time, the 5th toe will move out of its joint towards the 4th toe (medial). Now the head of the 5th metatarsal bone is sticking out leading to undo pressure from shoes and the ground. This constant pressure and friction on the bone will cause extra bone to form, leading to the bump that is seen on the side of the foot getting larger. The 5th toe will continue to shift towards the 4th toe causing an unbalanced joint.
Symptoms of a Tailor’s Bunion
Not all tailor’s bunions are painful. Someone may have a very severe deformity with no pain, while someone with a mild deformity can have significant pain. Patients can notice painful calluses develop (extra growth of hard skin). Most patients will complain of a deep ache and pain over the bump. There can be pain in the joint. There can be pain in the ball of the foot just behind the 5th toe. Some days may be more painful than others if the bursa (the gel-like sac of fluid between the bone and the skin) becomes inflamed from friction causing a bursitis. Numbness to the big toe can develop with constant friction of the skin and nerve over the bump protrusion. A painful hammertoe of the 5th toe may also develop. A bunion of the big toe (hallux abducto valgus) can be associated with a tailor’s bunion.
Causes Of a Tailor’s Bunion
Tailor’s bunions are primarily a genetic deformity. This means that most people that have a tailor’s bunion inherited it from someone in their family before them. If someone is destined to acquire a tailor’s bunion over time, it will form. However, there are factors that can increase the speed and severity in which the deformity will develop. Flat feet (pronation) are inherently unstable and tend to have loose ligaments around the 5th metatarsal leading to its shift. Significant use of high heel shoes with their small toe box can push the 5th toe closer to the 4th toe and place pressure over the head of the 5th metatarsal. Some patients with a high arched foot (pes cavus, supination) are more prone to a Tailor’s bunion due to the extra forces placed on the outside (lateral) aspect of the foot that are inherent in a high arch.
Diagnosing a Tailor’s Bunion
Diagnosis is simply achieved by the clinical examination and x-rays of the patient. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and evaluating their gait. Digital radiographs (x-rays) of the feet will be obtained in the office and reviewed with the patient. The positions of the bones and joints evaluated on the x-rays help to determine the severity of the deformity and any associated deformities.
Tailor’s Bunion Treatment Options
Dr. Soomekh educates that early diagnosis and treatment of a tailor’s bunion are keys to successful treatment, faster recovery and painless lifestyle.
Conservative Treatment for Tailor’s Bunion
Conservative treatments rely on their ability to accommodate a tailor’s bunion deformity. This can be achieved by wearing appropriate shoes with a wide toe box. If the shoe has room for the protruding bone, there can be less pain and discomfort. Any painful calluses can be removed in the office and will need to be maintained, as they will return. Padding over the bump can take the pressure off the area. Ice and anti-inflammatories can reduce the irritation when there is a flare. Custom molded orthotics can be made as an important tool to slow the progression of the bunion and prevent recurrence after tailor’s bunion surgery.
There is not a conservative way to stop a tailor’s bunion from forming or progressing. There is no conservative way to reverse a tailor’s bunion. Braces and straps cannot reverse the malposition of the joints and bones.
Surgical Treatment for Tailor’s Bunion
Dr. Soomekh will always recommend and attempt conservative treatment when appropriate. However, when a tailor’s bunion deformity becomes painful and many shoes are difficult to wear, surgical repair may be indicated.
Considering surgery can be intimidating. Foot surgery including tailor’s bunion surgery is not supposed to be painful during recovery. When the skin and the soft tissues are handled with care and focus, most patients experience little to no pain immediately after surgery and throughout the recovery period. Dr. Soomekh takes great care and focus to minimize the chance of postoperative pain. The goal of tailor’s bunion surgery is to realign the 5th metatarsal, remove the bump, alleviate pain, allow a return to normal shoes, and allow a return to all activities. Most procedures allow for immediate walking and a return to work while wearing a special walking boot. Dr. Soomekh performs the procedures in an outpatient setting at state of the art facilities.
There are many different procedures and techniques to repair a tailor’s bunion deformity. It is the responsibility of the surgeon to investigate each specific aspect of the bunion for each individual patient in order to formulate the proper procedure for repair. Dr. Soomekh will use the information gained from the patient’s symptoms, age, activity level, lifestyle goals, the severity of the deformity, the clinical examination, the patient’s gait, and the x-rays, to make a recommendation on the proper procedure.
Mild Tailor’s Bunion
In cases with a mild deformity a simple remedy can be to just remove the extra bone and protrusion of the head of the 5th metatarsal. A small incision is made on the side of the 5th toe joint and metatarsal. The extra bump is removed. Dr. Soomekh will then close the skin using plastic surgery techniques.
Moderate to Severe Tailor’s Bunion
In larger deformities, the actual bone will need to be shifted in order to reduce the pressure on the bone. A small incision is made on the side of the 5th toe joint and metatarsal. The extra bump is removed. A precision cut is made at the head of the 5th metatarsal (osteotomy). This bone is now shifted over the original bone closer to the 4th metatarsal, reducing the deformity. This bone is then stabilized with 1 or 2 small screws. The screws hold the bone in its new corrected position while the bone heals. Once the bone heals, the screws are not needed and are generally not removed. If there is a deviation of the 5th toe, it is now realigned by releasing one set of ligaments and tightening the other set of ligaments bringing the big toe straight in the joint. Dr. Soomekh will then close the skin using plastic surgery techniques.
Dr. Soomekh has perfected and reinvented these surgical procedures and techniques and is recognized by his peers as one of the top tailor’s bunion specialists and bunion surgeons in the Los Angeles area.