Also called a bunionette, the Tailor's bunion is a deformity involving the fifth metatarsal head. It appears as an enlargement on the outside (lateral) of the foot at the fifth metatarsophalangeal joint, near the base of the small toe. It commonly becomes painful due to enlarged prominence of the metatarsal head with overlying bursa or callus formation.
Symptoms
Symptoms include: redness, swelling, and pain at the site of the enlargement. They occur with shoes that rub the area or when excessive weight bearing is applied to the metatarsal head.
This deformity is caused by an inherited faulty mechanical structure of the foot. Sometimes, there is an actual "bowing" outward of the metatarsal shaft, while other cases involve splaying of the foot (in which all of the metatarsals are spread apart with weight bearing). In some cases, an actual bony spur may develop on the lateral side of the fifth metatarsal head. Regardless of the cause, the tailor's bunion is usually aggravated by the use of narrow shoe gear.
Diagnosis
The diagnosis of Tailor's bunion is made earlier via clinical findings of a painful enlargement at the fifth met-head region. Weight bearing radiographs are utilized to determine the exact cause and extent of the deformity.
Treatment Plans
Non-surgical treatment options may include: shoe modifications and the use of custom orthotic devices to control abnormal forefoot function. The use of NSAIDs, padding, and ice have shown some success. Injection therapy with corticosteroids is frequently used to reduce the inflammation of the soft tissue around the joint. Surgical options are utilized after careful consideration of the extent of the deformity seen on x-ray films, patient's age, activity level, as well as other factors.
Procedures may involve any combination of resection or bony prominence partial metatarsal head resection or metatarsal shaft osteotomy with internal fixation. Surgical correction of the Tailor's bunion is usually performed under local anesthesia, with or without IV sedation, and is highly successful in the treatment of the painful condition.
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