Anatomy of the Foot and Toes

Nearly one-fourth of all bones in the human body are in the feet. The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments, all working together to enable movement and balance. The foot is divided into three sections, the forefoot, midfoot and hindfoot. The forefoot has five toes (14 phalanges) and five longer bones (metatarsals). One phalanx of each of the five toes connects to one of the five metatarsals.

The big toe, or great toe (hallux), is made up of two joints. The metatarsophalangeal joint (MTP) is the largest of these, and the closest to the base of the toe, where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). In the MTP joint, as in any joint, the ends of the bones, where they touch, are covered by articular cartilage, a smooth substance that protects the bones and enables them to move easily.

Difficulties with the feet and toes can lead to more serious problems, not only for the feet, but also for other areas of the body, including the spine. Certain foot and toe problems may be caused by footwear that fits improperly, does not accommodate normal foot alignment, or that interferes with natural movement and balance of the body.

What is a Tailor’s Bunion or Bunionette?

A tailor’s bunion, or bunionette, is a painful bony growth or bump that develops on the outside of the foot, where the little toe, or pinkie toe, meets the foot—at the fifth metatarsophalangeal (MTP) joint. Although the causes and symptoms are similar to that of a bunion, which occurs on the inside of the foot, a tailor’s bunion is less common.

Why Are They Called Tailor’s Bunions or Bunionettes?

The deformity was named tailor’s bunion centuries ago, when tailors often sat cross-legged for hours with the outside of their feet rubbing against the ground. This constant friction at the base of the little toe resulted in the painful bump. Because a tailor’s bunion is basically a smaller version of a bunion, healthcare providers sometimes refer to them as bunionettes.

Symptoms of a Tailor’s Bunion or Bunionette

  • Pain, irritation or inflammation, especially when wearing shoes that rub against the bunionette
  • Discoloration or redness
  • Swelling
  • Calluses or corns on the little toe
  • Little toe is crooked or bent inwards, toward the other toes

Left untreated, a tailor’s bunion will worsen over time, growing larger, and causing more or worsened symptoms. An uncorrected bunionette may also increase your risk of developing other toe or foot problems, such as bursitis, hammertoes or arthritis of the foot.

Causes and Risk Factors

Tailor’s bunions are caused by extra pressure on the little toe, or fifth MTP joint. Over time (often years), that pressure can push the joint inward, toward the other toes, and out of its natural alignment. The bunionette forms as the body tries to compensate for the toe being pushed out of its normal position.

Causes and factors that increase your risk of developing a tailor’s bunion include:

  • Gait or the way you walk
  • Wearing shoes that are narrow, crowd the toes (narrow toe box), or have pointed toes
  • Inherited faulty mechanical structure in the foot
  • Standing or working on your feet for long periods of time
  • Bone spur on the side of the fifth metatarsal head
  • Rheumatoid arthritis, lupus, or other health conditions that cause inflammation
  • History of foot injuries
  • Biological parents with bunions or issues with foot mechanics
  • Women are more likely than men to develop a bunionette due to genetics, foot structure, hormonal changes, and certain footwear choices

Nonsurgical Treatment

Treatment usually begins with nonsurgical therapies, such as:

Footwear modifications—Avoid pointed toes and high heels; switch to shoes with a wide, deep toe box; in some cases existing footwear can be widened by a cobbler, or with a shoe stretching device at home.

Bunion pads and taping—Relieve pressure and pain by cushioning the bunionette with over-the-counter (OTC) bunion pads; medical tape may also be used to hold the toes in the correct position.

Orthotic devices—Shoe inserts, custom orthotics, or a spacer between toes may be recommended.

Icing—Ice or cold packs may be applied to help reduce pain and inflammation. To do this properly, apply crushed ice directly to the painful area, but over a thin cloth. Ice should not be applied directly to the skin and should be applied for no more than 15 to 20 minutes at a time, waiting at least one hour between icing sessions. Chemical cold products (“blue” ice) should not be placed directly on the skin and are not as effective.

Nonsteroidal anti-inflammatory medication (NSAIDs)—Drugs such as ibuprofen or naproxen may be taken orally to help relieve pain, inflammation and swelling but they must be taken carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.

Topical medications (creams, gels, sprays or ointments)—Topical nonsteroidal anti-inflammatory medications (NSAIDs) that are applied and rubbed into the skin around the bunionette may be recommended for pain relief.

Steroid-based injections—These powerful anti-inflammatories can help decrease pain and inflammation for short-term relief.

Surgery

New advancements in minimally invasive correction of Tailor’s bunion deformities have allowed for faster recover, less pain and swelling, and more cosmetically pleasing results than traditional open surgery. If your bunionette makes walking difficult, or pain continues despite nonsurgical treatment, your podiatrist may recommend minimally invasive surgery after considering your specific deformity and its severity, as well as your age, activity level, and other factors. Be sure to discuss potential risks and benefits with your surgeon prior to any procedure.