What is a Bunionette?
A bunionette is a bony lump which forms on the outside of the foot at the first joint of the small toe; where the toe joins the foot.
The causes of little toe bunions is not always known although they are believed to form in response to excess and repeated pressure. Pressure is usually exerted by tight and restrictive footwear; although it can also come from sitting cross legged on the floor for long periods of time.
This is the reason why a little toe bunion is often referred to as a tailor’s bunion. Tailors used to sit cross-legged on the floor for long periods of time while making clothes, which caused bunions to form on the outside of both feet. These days, this toe deformity is most commonly suffered by women, especially those with a love of stilettos and high heeled or tight and restrictive shoes. There is however a strong genetic component, and the condition can result from anatomical problems with the feet.
Bunionettes are Caused by the Choice of Footwear
Fashionable footwear for women tends to have a narrow and restrictive toe box which pushes the big toe outwards and the little toe inwards. When the toes are pushed out of their normal alignment, weight distribution in the feet changes. Instead of a normal push off from the toes with the forces acting straight down the toe bones, force is applied to toes which are out of alignment and the joints of the toes are not best equipped to deal with the forces in these positions.
Symptoms of a small toe bunion are fairly easy to identify, even in the early stages of formation. The first joint of the small toe moves outwards, the little toe angles inwards towards the others and a bony lump forms on the outside of the foot. This lump is irritated by rubbing against the inside of a shoe and it can easily become inflamed. A callus or corn may form on the outside of the foot from friction, or the skin can become broken. The area around the joint can also become swollen. Due to inflammation, the area around the bunion may become hot to the touch. Normally pain is more severe when pressure is applied to the bunion, after walking for long periods or from wearing shoes. Pain usually subsides with rest.
How Does a Bunionette Form?
A small toe bunion forms when the metatarsal head moves outwards. Often new bone forms around the joint. The skin on the outside of the small toe thickens – a process called hyperkeratosis – to toughen it up and prevent the skin breaking. This tough skin will help to prevent infections from taking hold, as broken skin means bacteria have an easy route into the body.
Over time however, the bony lump will become more pronounced, and new bone may prevent the toe from naturally straightening. When a little toe bunion is allowed to develop and it is not treated, the joint may have so much new bone laid down that it may not be able to move at all, even when attempts are made to physically manipulate it. When a little toe bunion gets this bad, bunion surgery is the only treatment option.
Treatment is usually straightforward; however it can take months for a bunion to heal. When a little toe bunion is not particularly severe, a simple change of footwear may be all that is required to correct the problem. Changing to shoes without a heel and with a wide toe box will allow the little toe to assume its natural position. If the little toe bunion is more pronounced, toe stretchers may be called for to manipulate the toes back into their normal position, or toe straightening devices may need to be worn inside shoes.
Bunionette surgery – called a bunionectomy – is required when the new bone deposits do not allow the toe to return to its normal position even with manipulation. Surgery is usually a minor operation which is conducted on an outpatient basis. The procedure sees excess bone removed to enable to the to be straightened. Sometimes the tendons may need to be repositioned to hold the toe in place. In severe cases the toe may need to be pinned permanently in a straight position, which will cure the bunionette but will mean the little toe can no longer be bent.