A tailor’s bunion (bunionette) is a bony lump which forms on the outside of the foot where the metatarsal bone joins the little toe. The deformity occurs when the head of the fifth metatarsal bone displaces and moves outwards causing a bony protuberance on the side of the foot. A tailor’s bunion always forms at the metatarsophalangeal joint of the fifth metatarsal bone and often occurs on both feet.

As the condition progresses, the bony lump increases in size and becomes more painful. There can also be an associated enlargement of the joint. The skin over the bunion can become very sore and tender to the touch and lesions can form due to friction from footwear. When the skin becomes broken there is a considerable risk of the infection.

It is not unusual to also have calluses over the bunion. The pain from bunions can cause people to walk in a different way and the resultant change pressure distribution while walking can cause calluses to form on the underside of the foot as well.

Most people experience intermittent pain from their little toe bunions but the pain can become chronic. Pain is usually at its worst during and shortly after walking or when wearing shoes.

Causes of Little Toe Bunions

This type of foot deformity is a hereditary trait, so if other members of your family have little toe bunions there is an increased risk that you will develop them at some point in your life. The risk of bunion formation tends to increase with age, and women are at a much higher risk of developing this type of toe deformity than men.

A tailor’s bunion is so called because it was a frequent ailment seen in the clothing industry. Tailors used to spend long periods of time sitting in cross-legged position on hard floors whilst making their clothes. The pressure exerted on the joints from sitting in this position often saw little toe bunions form on both feet.

These days tailor’s bunions are most commonly associated with footwear choice. Narrow and restrictive footwear, especially shoes with a pointed toe box, are often to blame. Shoes constructed from modern synthetic unyielding materials are particularly bad for the feet. When a narrow restrictive toe box is combined with a high heel is even worse. When the heel is raised the weight of the body shifts almost entirely onto the ball of the feet and the toes, increasing pressure on the delicate joints of the little toes.
Whether footwear alone is responsible for the formation of bunions on the little toe is not known, only that it increases the risk of little toe bunions forming considerably.

Tailor’s Bunion Risk Factors

• Arthritic joints
• Flat feet
• Muscular problems and imbalances
• Foot deformities
• Gait irregularities
• Family history
• Restrictive, narrow footwear

Treatment Options

A tailor’s bunion usually responds well to conservative treatments. Approximately 70%-90% of people do not require any surgical correction. There are a range of home treatment options available which improve the alignment of the toes, encourage the little toe back into the correct position or decrease the pressure exerted on the side of the foot from shoes. Orthotic inserts in shoes can be used to good effect if there is an underlying bone or gait problem.

Tailor’s bunion surgery – termed a bunionectomy – is usually only required to treat severe cases when the little toe can no longer be manually manipulated back into the correct position. Over time bone can be laid down on the metatarsal head and the joint can degrade.

A bunionectomy involves removal of excess bone, repositioning of the toe back into the normal position and in some cases, the little toe may need to be pinned in place.

Pain Relief

Bunion pain and inflammation can be eased with over the counter anti-inflammatory drugs. If bunion pads are inserted into shoes they can ease the pressure on the side of the foot and should ease pain and make walking more comfortable. The best thing to do if you have developed a tailor’s bunion is to change to wide footwear, shoes with yielding uppers or open toed sandals. If bunions are inflamed and swollen, try applying an ice pack a few times a day. Ice decreases inflammation, is a painkiller and will reduce swelling. Bear in mind that ice should not be placed directly against the skin.

Possible Complications

There are a number of complications which can develop as a result of little toe bunions which include:

• Bursitis
• Arthritis
• Infections
• Corns
• Calluses
• Hammer toes

If the causative factors are not eliminated and your tailor’s bunion is left untreated it is unlikely to go away. It is therefore strongly advisable to visit a podiatrist or a doctor to have your feet assessed and to find out the root cause of the problem. Treatment can then be administered to correct your little toe bunions and changes made to ensure that once cured, your little toe bunions will not come back.