A baby bunion, bunionette or tailors bunion are all terms used to describe a bunion deformity along the outside of the foot. When we think of a traditional bunion, we think about the big toe being involved and typically an associated bump on the inside of the foot that becomes painful with shoe wear and activity. A bunionette is essentially the same problem, but instead of involving the inside of the foot and the big toe, it involves the outside of the foot and the little toe.
The term tailor’s bunion, as it is commonly referred to in the Podiatric world, derived its name from clothing tailors who would sit on the floor cross-legged, while tailoring pants. Pressure between the ground and the outside of the foot while the tailors were working led to pain and irritation with the creation of a small bump in the area and thus the term Tailors bunions.
Although Tailors, at least good ones, are becoming increasingly harder to find, this deformity still presents itself quite frequently in a Podiatric practice. The same etiology applies today, although the pressure isn’t between the foot and the floor, but rather the outside of the foot and a tight-fitting shoe. Now, lets be clear about one thing, it is not solely pressure that causes pain along the outside of the foot and creation of a tailors bunion, but when that pressure is combined with predisposing foot types, the result is often a bunionette.
Foot types that predispose individuals to the development of a tailor’s bunion are numerous but the most associated foot type is called a splay foot. A splay foot, is exactly what it sounds like: It is a foot that with walking will splay or spread out fairly widely requiring a greater amount of space for normal walking. When the foot wants to spread widely, but due to the constraints of shoes it is not able to, the foot gets pressed up against the sides of the shoe and begins to rub and become irritate. The rubbing and irritation leads to responses from both the skin and bone underneath the pressure area leading to callous formation and reactive bone growth, creating that ‘bump.’
In some instances, a congenital outward bowing of the 5th metatarsal bone (the 5th long bone in the foot between the rearfoot and forefoot) is the root cause. In patients with this congenital bone abnormality, tailors bunions may present sooner in life, rather than in a patients 40’s or 50’s as the typical tailors bunion does.
Treatment options include a vast array of choices from conservative to surgical and the choice depends largely on the patients pain and discomfort in combination with a physical and clinical examination of the condition. Your Podiatrist will ask you a variety of questions to determine how fast the deformity is progressing and what methods of treatment, if any, you have previously tried. They will examine the deformity clinically to determine where the pain is localized to, the degree of soft tissue involvement, the condition of the joint, the rigidity of deformity, and the underlying etiology. Your Podiatrist will also take bilateral radiographs of your feet to evaluate the joint and bone positions in comparison to “standard” radiographic angles.
Once all the pieces of the examination have been considered together, it is most likely that conservative options will be exhausted prior to surgical intervention. Conservative treatments include: periodic shaving of the calloused tissue to relieve pressure; injections to decrease inflammation and alleviate pain; padding of the toe to decrease pressure with shoes; and orthotics, which attempt to realign the foot in a more optimal position decreasing the splaying of the foot that may be the root etiology of your tailors bunion.
If all conservative treatment options have been explored and the patient still complains of a significant amount of discomfort, surgical options are the next step. Next week we will talk about several of the surgical options for treating you tailors bunion and what to expect if you opt for surgery.