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 pain with 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 small 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 considered 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 video shows a tailor's bunionectomy with 5th metatarsal osteotomy.



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.

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There are 5 metatarsal bones that connect the arch of the foot to the toes. The 5th metatarsal is the most lateral (outside #13) of the metatarsal bones. Tailor's bunions occur at the head of the 5th metatarsal, just proximal to the 5th toe. Tailor's bunions are often confused with corns of the 5th toe due to their proximity.

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The symptoms of a tailor's bunion include pain with direct pressure from a shoe.  Symptoms include burning, redness and aching at the lateral aspect of the 5th metatarsal phalangeal joint (5th toe joint).

The differential diagnosis for a tailor's bunion should include;

Arthritis

Bursitis

Gout

Metatarsal fracture

Metatarsalgia

Pseudogout

Septic joint

• Mortons Neuroma

• Metatarsalgia

• Corn And Callus

• Forefoot Pain

• Metatarsal Fractures

This article was written by Jeffrey A. Oster, DPM and last modified on 5/17/10/10.  No additional references are available for this article.