5th Metatarsal Bunion (Tailor’s Bunion)

Tailor’s bunions are a prominence on the lateral (outside) of the foot caused by a structural deformity of the fifth metatarsal in effect increasing the metatarsal (IM°) angle and shape.  This is usually caused by genetics, however can be made worse with other conditions like improper shoes, athletic activity, and trauma.  A tailors bunion results in a repositioning of the 5th metatarso-phalangeal joint (MPJ). The problem usually causes pain because of impingement of the nerves in the region.  This can lead to difficulty wearing normal shoes, participating in athletic activity, and ultimately a lifestyle without pain.

Most shoes (particularly for professional women) are not designed with consideration of this condition or foot shape. Thus, the condition will escalate in women who are required to wear professional shoes.  If left untreated, tailors bunions usually continue to get worse and can lead to neuroma formation and bursa formation and bursitis. With increased time, bone quality, healing potential, and overall health deteriorates making surgery a difficult consideration later in life.

The Procedure

Tailors bunionectomy surgery involves a few basic steps.  The first step is dissection and exposure of the bony deformity.  This step requires an incision on the lateral side of the foot over the MPJ.  This incision is then deepened to the level of the joint capsule.  This is a layer of ligamentous tissue that is thick and covers the entire joint.  The capsule is incised to expose the joint (it will be repaired later).  At this time, the bump is removed with a bunionectomy.  If required, an osteotomy can be performed.  The bone is cut and shifted laterally to reduce the angle.  If an osteotomy is performed, it has to be fixated with a compressive screw.

If there is a large deformity, a skin flap may be used to reduce the redundant skin left by the surgical reduction. The tissues are repaired and the skin is closed.  A tendon transfer, bone or tissue graft maybe performed in addition to the basic steps to provide the best result for your particular condition.

During the procedure, if your surgeon notices that extra steps are required to improve the outcome of the procedure, these steps will be performed in addition to the bunion surgery.  These can include a tendon transfer, sesamoid release, sesamoidectomy, bone or tissue graft.

Possible Complications Related to Tailors Bunion Surgery

Recurrence

Similar to bunion surgery, tailors bunions can experience recurrence, and come back, if there is a dislocation or rotation of the osteotomy site.  Although this is rare because of the fixation systems, when it does happen, it can create a smaller version of the original tailors bunion.  Sometimes the rotation or dislocation can accentuate the correction which results in no visible problems, but on x-ray the alignment is less than optimal.