Bunions are a well known and painful foot deformity involving the big toe joint. Less known, but no less important, is the Tailor’s bunion. A Tailor’s bunion is a foot deformity on the other side of the foot from a traditional bunion. In essence, a Tailor’s bunion (also called a bunionette) is either an enlargement of the end of the outer long bone of the foot (5th metatarsal), or it is a spreading or bowing of this bone away from the foot. The result either way is pressure of the joint at the base of the little toe against the skin on the outside of the foot. Tight shoes will initially aggravate this site, causing skin irritation where the rubbing occurs. Eventually, the irritation will spread to the tissue underneath the skin, and a protective body called a bursa may develop to pad the surface between the skin and the prominent bone. In time, this bursa can become inflamed, as well as the tissue covering the joint under neath it, leading to bursitis and capsulitis respectively. In advanced cases, pain and irritation can develop even in the absence of a shoe, simply with pressure from barefoot walking.
Traditional myth holds that the name ‘Tailor’s bunion’ is derived from the way tailor’s would sit and sew, with the feet cross-legged and underneath the body. In this position, the outside of the foot receives great pressure, and the little toe joint would therefore become irritated and inflamed after awhile. Certainly not seen only in tailors, this condition in actuality has its origins in genetics and foot structure. with either structural instability or enlargement of the bone leading to the deformity over time. Tight shoes do not really cause this condition, but they certainly will encourage inflammation of the tissue over the bone, leading to pain and a definite awareness of the deformity if it was not noticed before.
Treatment for Tailor’s bunions can vary. Changing the shape and width of shoes worn on a daily basis is the first element of treatment. The majority of the time when a Tailor’s bunion is painful, these shoes will be narrow or pointed. Women’s dress shoes, and certain types of men’s dress shoes or reinforced boots will cause these symptoms. Sometimes a simple conversion to a wider or more box-shaped shoe will alleviate all discomfort. With some people, however, even roomier shoes will cause discomfort. This is mainly due to the inflammation occurring under the skin. Padding inside the she has questionable effectiveness. The inflammation itself can be treated with anti-inflammatory medications or injections for at least temporary pain relief. In some cases, the use of prescription inserts (orthotics) can stabilize the 5th metatarsal, and limit the amount of instability, leading to a lessening of Tailor’s bunion symptoms. Long term use of orthotics may even help limit the development of a Tailor’s bunion if begun at an early age.
In order to permanently correct a Tailor’s bunion,, surgery is needed. Surgery essentially involves removal of the bone prominence. If the side of the bone is simply enlarged, the surgeon can shave the enlarged portion off. Healing for this is relatively quick, with most patients returning to a regular shoe within a few weeks. If the bone position is abnormal and angled outward, a procedure to return it to a correct position is required. In this procedure the bone is cut and moved in such a way that the normal position is restored, and screws, wires, or a plate are used to hold the bone down so the cut end can heal. Recovery takes six weeks on average, usually while in a walking boot, although some surgeons may prefer a cast in certain cases. Both these surgeries tend to be quite successful, and have low rates of significant complications.
Scott R. Kilberg DPM 