A
tailor's bunion is a prominence of the lateral aspect of the 5th metatarsal
head. The term tailor's bunion was coined in the age when a tailor would
sit cross legged on the floor putting up the hem on a coat or dress. The
constant pressure applied to the lateral aspect of the foot resulted in pain at
the 5th metatarsal head. Tailor's bunions also go by the name bunionette
or baby bunion.
The most common cause of a tailor's bunion is direct pressure to the lateral
aspect of the 5th metatarsal head from tight shoes. Pressure from shoes
will initially present as a red spot or blister over the 5th metatarsal head.
If pressure persists, a bursa can form over the 5th
metatarsal
head. A bursa is a s
mall
fluid filled sac that forms in response to chronic pressure against the bone.
Bursitis, or inflammation of the bursa is commonly found in conjunction with a
tailor's bunion.
The shape of the 5th metatarsal can also contribute to the presence of a
tailor's bunion. Lateral bowing of the 5th metatarsal can make the
forefoot much wider. This can make shoe fitting much more difficult.
Bowing is a significant issue to be evaluated when electing to perform surgery
for a tailor's bunion.
Treatment of Tailor's Bunions -
Conservative care for a tailor's bunion includes
padding and the
use of wider, softer shoes. Shoes can be spot stretched with a ring and
ball stretcher to make the area of the shoe adjacent to the tailor's bunion a
bit wider (ask your local pedorthist or shoe repair shop for help on spot
stretching). Another important consideration is the shape of the toe box
of the shoe. When buying shoes, be sure to buy a shoe with a toe box that
is shaped like your foot. To be sure the toe box is shaped like your foot,
stand in your socks next to the new shoe and compare the shape of your foot and
the shape of the toe box. If the two don't seem to be the same shape, then
perhaps that's not the right pair of shoes for you.
Planing
for surgical treatment of a tailor's bunion depends upon the degree to which the
5th metatarsal is bowed. With minimal bowing, a simple partial metatarsal
head resection can be performed. A partial metatarsal head resection
removes the lateral head of the 5th metatarsal. In cases of mild to
moderate bowing, a distal metatarsal osteotomy is performed in conjunction with
the partial head resection. Severe cases of bowing require a mid-shaft
osteotomy with plating.
Another
procedure used to treat a tailor's bunion is a 5th metatarsal head resection.
This procedure will result in the shortening of the 5th toe but is great in the
patient population who cannot tolerate a period of non-weight bearing or
casting. Patients with co-morbidities that may effect the surgery may be
candidates for a 5th metatarsal head resection. Examples of these
co-morbidities include obesity, severe arthritis, propensity to DVT and gait
abnormalities. This is a population of patients that you want to keep as
ambulatory as possible to prevent post-op complications. Diabetic patients
also do quite well with 5th metatarsal head resections.
Another important consideration in planing tailor's bunion surgery is to be
sure that the surgery is consistent with the location of the problem. Pain
at the 5th metatarsal head can be due to pressure on the side of the metatarsal
head, the bottom of the metatarsal head or both. A partial metatarsal head
resection will only address pain on the lateral aspect of the 5th metatarsal
head. To treat pain found on both the lateral aspect of the 5th metatarsal
head and the bottom of the metatarsal head, a 5th metatarsal osteotomy or
metatarsal head resection must be performed.
The following images show a tailor's bunionectomy with 5th metatarsal
osteotomy. Image 1 shows the approach marked on the dorso-lateral aspect
of the distal 5th metatarsal. Image 2 shows the 5th metatarsal head free
of soft tissue and a bone saw being used to resect the tailor's bunion.
Image 3 shows a saw being used to create the 5th metatarsal osteotomy.
Image 4 shows fixation with a Kirschner wire and image 5 shows final skin
closure.
Tailor's bunion surgery can be performed on an out-patient basis at a
hospital or surgery center. The most common anesthesia used for this
procedure is a local anesthetic with sedation. General or spinal
anesthetics may also be used based upon the surgeon's preference. The
procedure takes approximately 20-30 minutes to perform. The post operative
course varies based upon the procedure performed. Patients who undergo a
partial head resection are able to bear weight on the foot the same day.
Partial head resections with an osteotomy may be able to partially bear weight
and are likely on crutches for several weeks. Plating for severe
deformities will require a hard cast and non-weight bearing for a period of at
least 6 weeks. Return to normal shoes and activities also depends upon the
choice of procedure.
