Bunionette Surgery

What is a bunionette?

A bunionette, also known as tailor’s bunion, is bony prominence at the base of the pinky toe, which often results in pain, redness and rubbing in footwear. A bunionette can change the shape of your foot, make it difficult for you to find shoes that fit correctly and worsen the symptoms if left untreated.

What are the causes of a bunionette?

Although it is not clearly understood why bunionettes occur, possible causes include:

  • Family history and genetics
  • Arthritis (inflammation of the joints) including rheumatoid arthritis, psoriatic arthritis and gout
  • Neuromuscular conditions such as cerebral palsy (affects movement and co-ordination)
  • Connective tissue disorders such as Marfan’s syndrome (affects the connective tissues)
  • Tight fitting shoes that are too tight, narrow or high heeled.

What are the Symptoms of a Bunionette?

The main indication of a bunionette is a prominence at the base of the pinky toe on the outside of the foot.

Other signs and symptoms include:

  • Pain and swelling over the big toe that increases while wearing shoes
  • Swelling with red, sore and calloused skin at the base of the big toe
  • Inward turning of the big toe pushes the second toe out of place
  • Bony bump at the base of the big toe
  • Sore skin over the bony bump
  • Difficulty walking and wearing shoes

How is a Bunionette Diagnosed?

The diagnosis of a bunionette by an orthopedic surgeon includes taking a medical history, and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. Your surgeon will usually order weight bearing X-rays (i.e. taken while standing) to access the severity of the bunionette and deformity of the toe joints.

What are the Conservative Treatment Options for Bunionettes?

Your doctor may have already initially recommended conservative treatment measures with the goal of reducing or eliminating your foot pain.

Such measures can include:

  • Medications for relieving pain and inflammation
  • Wearing surgical shoes with a wide and high toe box, avoiding tight, pointed or high-heeled shoes.
  • Use of orthotics to realign the bones of your foot and ease pain.
  • Padding the bunionette
  • Ice applications several times a day

Conservative treatment measures can help relieve the discomfort of a bunionette, however these measures will not correct the condition or prevent the bunionette from becoming worse. Surgery is the only means of correcting a bunionette. Surgery is also recommended when conservative measures fail to treat the symptoms of bunionette.

What are the Surgical Options for a Bunionette?

There are many surgical options to treat a bunionette. The shape of the 5th metatarsal will help guide your surgeon in deciding what option is best.

  • Chevron Osteotomy – this involves surgically cutting the bone to realign the joint at the base of the pinky toe.
  • Ostectomy – this involves shaving the bony prominence at the base of the pinky toe.

Special considerations

Traditional bunionette surgery involves an incision to expose the bony prominence at the base of the pinky toe. Recent advances have allowed the same surgery to be performed without the need for large incisions. Minimally invasive techniques can be used to perform the same surgery with smaller incisions. The incisions are often so small no sutures are needed and unsightly scars are minimized. This may allow you to get back to your daily activities faster with less downtime and less pain.

What are the Risks and Complications of Bunionette Surgery?

As with any surgery, bunionette surgery involves certain risks and complications and include:

  • Infection
  • Recurrence of the bunionette
  • Nerve damage
  • Unresolved pain and swelling
  • Joint stiffness or restricted movement
    • Delayed healing or healing in the wrong position

In rare cases, a second surgery may be necessary to correct the problems.

What is the Postoperative care for Bunionette Surgery?

Patients should follow all instructions given by the surgeon following the surgery. These include:

  • Keep your dressings dry and leave them in place until your next outpatient appointment.
  • Using the postoperative shoe for all walking.
  • Elevate the foot to minimize swelling as much as possible for the first 6 weeks.
  • You will have to wear specially designed Postoperative shoes to protect the wounds and assist in walking
  • You may not be able to wear regular shoes for 6 weeks