What is a bunionette?

A bunionette, also known as Tailor's bunion is a bony bump that forms on the joint at the base of the little toe. It is due to malalignment of the bones in the front of the foot that forces the joint at the base of your little toe to stick out. A bunionette can cause redness, swelling and pain over the prominence. You may also form hard skin (callus) in areas with increased pressure or rubbing. Over time, finding suitable footwear can become increasingly difficult.

What are the treatment options? 

Bunionette symptoms can be managed using wider fitting shoes and pads or silicone sleeves. These measures do not change the shape of your bunionette but aim to reduce pain.

If non-surgical treatment does not help, I may recommend surgery if you are symptomatic. Surgery entails realigning the toe through bone cuts (osteotomies). 

 

What does surgery involve?​

This procedure is usually performed as a day case. It is normally performed under general anaesthetic combined with a local anaesthetic block for pain relief. 

An incision is made over the bunionette. Part of the bunionette is removed and bone cuts (osteotomy) are made to realign the metatarsal. The bones are secured in its new position using small screws (see X-rays below). The skin is closed using dissolvable stitches and a bulky dressing is applied.

Your foot will be protected in an orthopaedic shoe for 6 weeks. You will be allowed to walk on the operated foot but taking most of your weight through the heel.

Metatarsal osteotomy for bunionette

 

Aftercare and FAQs

It is important to keep the foot elevated as much as possible especially for the first 3 days. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Wound care – The bulky dressing should be kept on until your first clinic appointment 12-14 days after surgery.

Walking - You will be able to walk on the day of your surgery unless advised otherwise.  You may mobilise freely around the house but long walks or standing for long periods should be avoided. Very rarely you may need to use a stick or crutches for a few days.

​Work - If you have a sedentary job you should be able to return to work within 2 weeks. If your job is physical, you may need to stay off work for at least 6 weeks.

​Driving - You will not be able to drive for 6 weeks following surgery. However, if you drive an Automatic and it was your LEFT foot that was operated on; then you may start short drives 2 days following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.

 

Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.

 

What are the surgical risks?

 

  • Infection - there is a small risk of infection with all surgery.

  • Swelling - this is quite common. In some people the swelling reduces within a matter of weeks and in others could take a few months. 

  • Deep Vein Thrombosis - also known as Thromboembolism (VTE), this is a rare complication of foot surgery.

  • Nerve damage – this may leave you with numbness or a sensitive scar

  • Toe stiffness 

  • Persistent or recurrent deformity

It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.

 

Mr Dev Mahadevan
Consultant Foot and Ankle Surgeon

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