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Bunionette

  • Author: Christopher Brown, MBBS, FRCSC, FRACS, FAOrthA; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
 
Updated: Apr 07, 2016
 

Background

The term tailor's bunion (a synonym for bunionette) initially described an acquired lesion that caused chronic pain and swelling over the lateral aspect of the fifth metatarsal (MT) head. These lesions often were present on tailors, whose traditional cross-legged sitting posture on benches resulted in pressure being placed on the lateral side of the foot, leading to the development of painful bunionettes. Davies described the lesion in the English literature in 1949.[1]

A bunionette is defined as a painful prominence on the lateral aspect of the fifth MT head. Although it is not as common as a medial bunion, it is a cause of chronic pain and shoe-fitting problems in individuals whose feet are characterized by a widened forefoot or in those who have a lateral splaying or prominence over the fifth MT.[2, 3]

For patient education resources, see Chronic Pain.

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Anatomy and Pathophysiology

The underlying pathoanatomy and pathophysiology determine procedure selection. No single, universally acceptable procedure exists for all patients.

The pathoanatomy of the bunionette varies with different types of lesions. Usually, there is a component of prominence of the lateral aspect of the fifth metatarsophalangeal (MTP) joint (MTPJ). Stretching and attenuation of the capsule may occur with medial subluxation of the proximal phalanx. Both long flexors and extensors can be medial to the head, leading to a deforming force on the toe that increases with increasing deformity. Rotation of the phalanx also can occur.

Pathologic lesions include the following:

  • Inflamed bursa overlying the lateral aspect of the MT head
  • Bony enlargement of the head itself
  • Increased intermetatarsal angle between the fourth and fifth MTs with secondary medial angulation of the phalanx and abnormal curvature of the fifth MT

The normal fourth and fifth intermetatarsal angle (IMA) is approximately 6.2°, and the normal fifth MTP angle is about 10°. Pathologic values are in the range of 10° for the IMA and 16° for the MTP angle. Lesions may be conveniently divided into three types (see Workup, Imaging Studies.)

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Etiology

Causes of bunionette can be extrinsic or intrinsic.[4] Extrinsic causes can be traumatic, either acute or (more commonly) chronic (eg, tailors' working posture, footwear). Intrinsic causes can be related to structural abnormalities, such as congenital lateral bowing of the MT shaft, abnormal intermetatarsal ligament insertion with prominence of the fifth MT, brachymetatarsia, or primary hypertrophy of the MT head. Congenital splayfoot is a more generalized congenital predisposing lesion.

Iatrogenic causes can occur as a result of failed adjacent MT surgery or residual malalignments from hindfoot surgery, which cause increased prominence of the fifth MT. Inflammatory arthropathies also can cause bunionette deformities or soft-tissue lesions in association with bony problems.

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Epidemiology

United States statistics

In Western society, the occurrence of bunionettes is related to narrow footwear on predisposed foot anatomy. The actual incidence is not accurately known, but it is far less of an isolated presenting problem than hallux valgus. However, it is commonly seen in patients who present with hallux valgus secondary to splaying of the forefoot. It may or may not be symptomatic at the same time. Females represent up to 90% of symptomatic patients in some series.

International statistics

Few reports exist in the literature on the incidence in non-Western countries. This is probably a result of lesser wear of constricting shoes and, hence, a lower occurrence rate.

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Prognosis

Relief of pain and imporved alignment usually can be obtained with surgical treatment. When cosmesis is the only reason for surgery, satisfaction is less likely because minor symptoms may persist for some months following surgery. Continuing progression of underlying arthropathic disease also may lead to recurrence and unsatisfactory results.

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Contributor Information and Disclosures
Author

Christopher Brown, MBBS, FRCSC, FRACS, FAOrthA Clinical Lecturer, Department of Orthopaedics and Trauma, University of Adelaide, Australia

Christopher Brown, MBBS, FRCSC, FRACS, FAOrthA is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Australian Orthopaedic Association, American Orthopaedic Foot and Ankle Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Vinod K Panchbhavi, MD, FACS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedics, University of Texas Medical Branch School of Medicine

Vinod K Panchbhavi, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.

Additional Contributors

James K DeOrio, MD Associate Professor of Orthopedic Surgery, Duke University School of Medicine

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society

Disclosure: Received royalty from Merete for other; Received royalty from SBi for other; Received royalty from BioPro for other; Received honoraria from Acumed, LLC for speaking and teaching; Received honoraria from Wright Medical Technology, Inc for speaking and teaching; Received honoraria from SBI for speaking and teaching; Received honoraria from Integra for speaking and teaching; Received honoraria from Datatrace Publishing for speaking and teaching; Received honoraria from Exactech, Inc for speaking a.

Acknowledgements

Nancy Cullen, MD, FRCSC, FRACS Senior Visiting Medical Officer, Clinical Lecturer, Department of Orthopaedics and Trauma, University of Adelaide, Australia

Nancy Cullen, MD, FRCSC, FRACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society

Disclosure: Nothing to disclose.

References
  1. Davies H. Metatarsus quintus valgus. Br Med J. 1949. 1:664-5.

  2. Ajis A, Koti M, Maffulli N. Tailor's bunion: a review. J Foot Ankle Surg. 2005 May-Jun. 44(3):236-45. [Medline].

  3. Cooper PS. Disorders and deformities of the lesser toes. In: Myerson M, ed. Foot and Ankle Disorders. 2000:335-340.

  4. Coughlin MJ. Etiology and treatment of the bunionette deformity. Instr Course Lect. 1990. 39:37-48. [Medline].

  5. Cohen BE, Nicholson CW. Bunionette deformity. J Am Acad Orthop Surg. 2007 May. 15(5):300-7. [Medline].

  6. Shimobayashi M, Tanaka Y, Taniguchi A, Kurokawa H, Tomiwa K, Higashiyama I. Radiographic Morphologic Characteristics of Bunionette Deformity. Foot Ankle Int. 2016 Mar. 37 (3):320-6. [Medline].

  7. Laffenêtre O, Millet-Barbé B, Darcel V, Lucas Y Hernandez J, Chauveaux D. Percutaneous bunionette correction: results of a 49-case retrospective study at a mean 34 months' follow-up. Orthop Traumatol Surg Res. 2015 Apr. 101 (2):179-84. [Medline].

  8. Legenstein R, Bonomo J, Huber W, Boesch P. Correction of tailor's bunion with the Boesch technique: a retrospective study. Foot Ankle Int. 2007 Jul. 28(7):799-803. [Medline].

  9. Kitaoka HB, Holiday AD Jr, Campbell DC 2nd. Distal Chevron metatarsal osteotomy for bunionette. Foot Ankle. 1991 Oct. 12(2):80-5. [Medline].

  10. Giannini S, Faldini C, Vannini F, Digennaro V, Bevoni R, Luciani D. The minimally invasive osteotomy "S.E.R.I." (simple, effective, rapid, inexpensive) for correction of bunionette deformity. Foot Ankle Int. 2008 Mar. 29(3):282-6. [Medline].

  11. Vienne P, Oesselmann M, Espinosa N. Modified Coughlin procedure for surgical treatment of symptomatic tailor's bunion: a prospective followup study of 33 consecutive operations. Foot Ankle Int. 2006 Aug. 27(8):573-80. [Medline].

  12. Weitzel S, Trnka HJ, Petroutsas J. Transverse medial slide osteotomy for bunionette deformity: long-term results. Foot Ankle Int. 2007 Jul. 28(7):794-8. [Medline].

  13. Weil L Jr, Weil LS Sr. Osteotomies for bunionette deformity. Foot Ankle Clin. 2011 Dec. 16(4):689-712. [Medline].

  14. Masquijo JJ, Willis BR, Kontio K, Dobbs MB. Symptomatic bunionette deformity in adolescents: surgical treatment with metatarsal sliding osteotomy. J Pediatr Orthop. 2010 Dec. 30(8):904-9. [Medline].

  15. Guha AR, Mukhopadhyay S, Thomas RH. Reverse' scarf osteotomy for bunionette correction: Initial results of a new surgical technique. Foot Ankle Surg. 2012 Mar. 18(1):50-4. [Medline].

  16. Magnan B, Samaila E, Merlini M, Bondi M, Mezzari S, Bartolozzi P. Percutaneous distal osteotomy of the fifth metatarsal for correction of bunionette. J Bone Joint Surg Am. 2011 Nov 16. 93(22):2116-22. [Medline].

  17. Weil L Jr, Consul D. Fifth Metatarsal Osteotomies. Clin Podiatr Med Surg. 2015 Jul. 32 (3):333-53. [Medline].

  18. Maher AJ, Kilmartin TE. Scarf osteotomy for correction of Tailor's bunion: mid- to long-term followup. Foot Ankle Int. 2010 Aug. 31 (8):676-82. [Medline].

  19. Kitaoka HB, Holiday AD Jr. Lateral condylar resection for bunionette. Clin Orthop. 1992 May. (278):183-92. [Medline].

  20. Radl R, Leithner A, Koehler W. The modified distal horizontal metatarsal osteotomy for correction of bunionette deformity. Foot Ankle Int. 2005 Jun. 26(6):454-7. [Medline].

  21. Waizy H, Olender G, Mansouri F, Floerkemeier T, Stukenborg-Colsman C. Minimally Invasive Osteotomy for Symptomatic Bunionette Deformity Is Not Advisable for Severe Deformities: A Critical Retrospective Analysis of the Results. Foot Ankle Spec. 2012 Jan 31. [Medline].

 
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Type 1 bunionette. Note enlarged head without marked angulation.
Type 2 bunionette. Note abnormal bowing of metatarsal and secondary angulation of metatarsophalangeal joint.
Type 3 bunionette. Note increased angle between fourth and fifth metatarsals. Angulation at metatarsophalangeal joint is secondary to medial pressure on phalanx.
 
 
 
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