Tailor’s bunion (bunionette) on the outer edge of the foot

What is a tailor’s bunion?

A tailor’s bunion, also called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe, on the outer edge of the foot.^[1,3] It resembles a bunion on the big toe side, but it is a separate condition with its own causes.^[3] Most bunionettes come from a wider angle between the fourth and fifth metatarsal bones, together with the little toe angling inward at its base joint.^[2] See bunions for the big-toe version.

Symptoms

• a firm bump on the outer edge of the foot at the base of the little toe
• redness, swelling and pain over the bump, especially in tight or narrow shoes
• calluses or corns over the bump or under the fifth metatarsal head
• in more severe cases, an open sore where the shoe rubs^[1,3]

What causes it?

The shape of the bone is the main factor, and it is often inherited: the fifth metatarsal bows outward or its head is enlarged, and the little toe angles inward. Sometimes a bony spur grows on the side of the metatarsal head.^[1] Experts consider bunionettes a mix of bone shape and imbalance in the soft tissues of the forefoot, and friction against narrow shoes turns the bump into a painful one.^[3] A review of scarf surgery for tailor’s bunions noted that calluses under the ball of the foot were the most common problem afterward, and one study linked them to a high-arched foot; see cavus foot.^[6]

How it’s evaluated

The bump is easy to see. We examine the foot and shoe fit, check the skin over the bump, and take X-rays while you stand to measure the angle between the fourth and fifth metatarsals and to identify the bone shape, which decides the surgical option.^[1,2] X-ray and ultrasound are available on site at our practice; see foot and ankle imaging. If other forefoot problems are present, such as a bunion, hammertoes or a callus under the ball of the foot, they are evaluated at the same time. See hammertoes.

Non-surgical care

Most symptomatic bunionettes respond to non-surgical treatment.^[3,2] Options include:

• shoes with a wide toe box, avoiding pointed toes and high heels
• padding over the bump (bunionette pads)
• anti-inflammatory medicine and ice
• corticosteroid injections in selected cases
• custom orthotic devices^[1]

Read more about non-surgical care. These measures can control pain, but they can’t change the shape of the bone.

When surgery is considered

Surgery becomes an option when pain persists despite non-surgical care. The surgeon considers the X-ray findings, your age, and your activity, among other factors.^[1] The operation is chosen from the shape of the bone and any associated calluses:

• Removing the bump (lateral eminence resection) is rarely enough by itself, because it carries a high risk of the bump returning or of too much bone being removed.^[2]
• A distal osteotomy (a cut near the toe end of the bone, often chevron-shaped) suits a bone that bows outward.^[2]
• A shaft or proximal osteotomy is generally used when the angle between the fourth and fifth metatarsals is wide.^[2,4]

A meta-analysis of 28 studies found that all types of bone cut corrected the deformity, with proximal cuts correcting the metatarsal angle the most and distal cuts having the fewest major complications.^[4] A review of the scarf osteotomy found good correction and patient satisfaction, a complication rate of about 15%, mostly recurring calluses under the ball of the foot, but the four studies were small and at high risk of bias.^[6] Small-incision (minimally invasive) osteotomies improved pain and X-ray angles in 18 studies (714 feet), but no study compared them directly with open surgery; the most common complication was a thickened callus at the site.^[5]

For the techniques used on the big-toe side, see bunion surgery and minimally invasive foot surgery.

When to seek care

Consider an evaluation if a bump on the outer edge of the foot hurts despite wider shoes, if calluses keep returning, or if the little toe is crowding its neighbor.