We just talked about what a tailors bunion is, including why it forms and how it can be treated conservatively. Just to refresh, a tailors bunion is much like the typical bunion except that it is located on the outside of the foot rather than the inside. The bone affected when a tailors bunion develops is the 5th metatarsal bone. There are a total of 5 metatarsal bones in the foot, each corresponding with a toe, such that the 5th metatarsal is located between the rearfoot and the 5th toe, along the outside of the foot.
Aside from an inherited bowing of the 5th metatarsal outward, most tailors bunions are caused by splaying of the foot with gait. This means that with each step, the foot widens out and when the sides of the foot come in contact with the shoe, excess pressure develops and eventually pain. As a result of the excess pressure, responses from both the skin and bone underneath the pressure area induce the formation of thickened skin (callus) and reactive bone growth on the head of the 5th metatarsal, creating the characteristic baby “bump” that is your tailors bunion.
There are a variety of conservative measures which we have already covered, so the aim this week is to briefly review a few of the more common surgical options, should all conservative methods fail.
Soft Tissue Procedures: Although there are various soft tissue procedures that can be used to correct for the traditional bunion located on the inside of the foot, because there are fewer and small structures surrounding the 5th metatarsal, 5th toe and outside of the foot, soft tissue procedures are typically unsuccessful and rarely attempted.
Bone Procedures: When addressing a tailors bunion there are two main options for which bowing of the metatarsal and reactive bone growth can be addressed. There is a “shave the bump” method and a “bone cut” method.
-Shaving the bump: This procedure basically involves removing or shaving off the outside portion of the 5th metatarsal head to prevent it from pushing up against a shoe. The reactive bone growth in addition to a small amount of the normal bone would be removed and smoothed down decreasing the size of the bump. This type of procedure does not require any pins or screws for fixation and is typically used for mild deformities with great success.
– Bone cuts: There are numerous procedures that can be performed where a bone cut would be made, but no matter which type of cut, all procedures aim to achieve the same result: decreasing the deformity and reducing pain/pressure. A bone cut allows the head of the bone (the portion closest to the toe) to be shifted over/inward that after healing reduces splaying of the foot with gait, decreasing pressure of the metatarsal bone against the shoe. This procedure does require a pin or screw that can be temporary or permanent depending on your Podiatrists preference, and is indicated for large tailors bunions.
As with any surgical procedure the risks and benefits should be considered and discussed with your Podiatrist. Complications with any of the tailors bunion procedures described above can include infection, scarring, recurrence of deformity, and transfer pain among others, although the risks of any such complications are minimal. Patients should expect anywhere from 2-6 weeks of recovery depending on the procedure selected and they should expect pain typical of healing during the recovery period, in addition to lingering swelling. Again, all conservative options should be explored prior to surgical intervention, but should surgery be appropriate, patients tend to do very well!