Bunion / Tailor’s Bunion

Anatomy

The big toe, also known as the hallux, meets the 1^st metatarsal bone to form the 1^st metatarsal phalangeal joint or the 1^st MPJ.

The 5^th toe meets the 5^th metatarsal bone to form the 5^th metatarsal phalangeal joint or the 5^th MPJ.

Condition

Bunion Deformity

A bunion deformity, also known as hallux valgus, results when the 1^st metatarsal bone is prominent along the inside (medial side) of the foot. Bunions are frequently referred as a “bump” on the inside of the foot. Not all bunions are painful, yet when they are they can be the source of significant pain, numbness, limitation of physical activity, and limited ability to wear shoes comfortably.

Tailor’s Bunion/Bunionette Deformity 

A Tailor’s bunion, also known as a bunionette deformity, results when the 5th metatarsal bone is prominent along the outside (lateral side) of the foot. Tailor’s bunions are frequently referred as a “bump” on the outside of the foot. Not all Tailor’s bunions are painful, yet when they are they can be the source of significant pain, numbness, limitation of physical activity, and limited ability to wear shoes comfortably.

Symptoms

Both bunions and Tailor’s bunions have similar symptoms with the only difference being the location of the pain.

1. Pain, generally sharp and throbbing in nature, is commonly felt along the “bump.” In advanced bunions, and Tailor’s bunions pain can be felt inside the joint itself
2. Numbness results from impingement of the dorsal medial cutaneous nerve (bunion) or the lateral cutaneous nerve (Tailor’s bunion) as it is trapped between the “bump” and the shoe
3. Swelling
4. Limited ability to wear shoes comfortably
5. Limited ability to participate in physical activity

Diagnosis 

Diagnosis is made by a comprehensive foot exam by Dr. Stewart along with x-rays of the foot.

Common causes

Both bunions and Tailor’s bunions have similar causes.

1. Shoes DO NOT cause bunions or Tailor’s bunions, yet if they do not fit properly shoes will aggravate bunions and Tailor’s bunions
2. Congenital/inherited predisposition to the deformity
3. Structural bone deformity
4. Imbalance of tendons and muscles
5. Flatfoot deformity

Treatment

Conservative treatment options are available for both bunions and Tailor’s bunions. If pain and limitation continues after all conservative care has been exhausted, then surgical intervention is generally recommended.  Dr. Stewart only recommends surgery for pain and limitation and never recommends surgery for cosmetic reasons.

Conservative treatment for bunions and Tailor’s bunions includes:

1. Supportive open shoe gear to keep pressure off of the prominent bone
2. Deeper and wider shoe gear
3. Custom foot orthotics
4. Ice along the joint 2-3 times per day for 20 minutes at the area of maximum tenderness. Elevation is recommended while icing
5. Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
6. Avoidance of flip-flops, flats, and barefoot walking
7. Supportive shoe gear including a motion control running shoe such as Brooks, Aasics, New Balance, or Saucony; Keen and Merrell style shoes are also recommended
8. Padding along the bunion

If all conservative care fails, then surgical intervention is recommended. There are many surgical options for bunion and Tailor’s bunion deformities and if surgery is indicated, Dr. Stewart will choose the right procedure for you. The goal of surgery is to remove the prominent bone and prevent recurrence of the deformity. The surgical recovery depends on the procedure performed.

Surgical treatment for bunions and Tailor’s bunions includes:

1. Simple removal of the prominent bone (bunionectomy)
2. Cutting of bone (osteotomy) and fixation with screws, plates, or wires
3. Fusion (arthrodesis) of the 1^st metatarsal phalangeal joint with plates and/or screws for bunions
4. Joint implant
5. Fusion of the 1^st metatarsal-medial cuneiform joint with plates and/or screws for bunions
6. Joint resection (arthroplasty)