Bunionette Workup

  • Author: Christopher Brown, MBBS, FRCS(C), FRACS, FAOrthA; Chief Editor: Jason H Calhoun, MD, FACS   more...
 
Updated: Feb 17, 2012
 

Laboratory Studies

  • Obtain standard preoperative hematology tests.
  • Investigation of arthropathy or diabetes also may be necessary.
  • Cultures may be obtained for infected lesions. More accurate bacteriological diagnoses of infected lesions are obtained from operative specimens.
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Imaging Studies

  • Obtain standing weight-bearing views of both feet. These films should be recent, especially in rheumatoid and arthropathic cases.
  • Deformity classification obtained from plain films is as follows:
    • A type 1 lesion has an enlarged head as an isolated lesion (see the image below).Type 1 lesion. Note enlarged head without marked aType 1 lesion. Note enlarged head without marked angulation.
    • A type 2 lesion has an abnormal lateral bowing of the fifth metatarsal (see the image below).Type 2 lesion. Note the abnormal bowing of the metType 2 lesion. Note the abnormal bowing of the metatarsal and the secondary angulation of the metatarsophalangeal joint.
    • A type 3 lesion has a 4/5 intermetatarsal angle in excess of the normal 6-8° (see the image below).Type 3 lesion. Note the increased angle between thType 3 lesion. Note the increased angle between the fourth and fifth metatarsals. The angulation at the metatarsophalangeal joint is secondary to medial pressure on the phalanx.
      • Attenuation of the intermetatarsal ligament between the fourth and fifth metatarsal shafts usually is found in type 2 and 3 lesions. Bunionettes of type 1 with an enlarged head may not have significant capsular attenuation, and they do not necessarily have increased intermetatarsal angles or even angulation at the MTP joint.
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Other Tests

  • Vascular studies are prudent in patients with questionable vascularity.
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Staging

Other than the pathoanatomic classification (see Workup, Imaging Studies), no specific staging classifications for the lesion exist. Some authors have referred to mild or severe deformity, but no indication is given to define the limits used.

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Contributor Information and Disclosures
Author

Christopher Brown, MBBS, FRCS(C), FRACS, FAOrthA  Clinical Lecturer, Department of Orthopaedics and Trauma, University of Adelaide, Australia

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

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Specialty Editor Board

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, Florida Medical Association, and German Society of Neurology

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Shepard R Hurwitz, MD  Executive Director, American Board of Orthopaedic Surgery

Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS  Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

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. May-Jun 2005;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. May 2007;15(5):300-7. [Medline].

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

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

  8. 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. Mar 2008;29(3):282-6. [Medline].

  9. 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. Aug 2006;27(8):573-80. [Medline].

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

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

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

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

  14. 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. Nov 16 2011;93(22):2116-22. [Medline].

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

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

  17. 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. Jan 31 2012;[Medline].

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