Most people have heard of or seen a bunion at some time on the foot. When there is a bump on the outer side of the foot near the little toe, it is a Tailor's bunion. It is also called a bunionette. This foot deformity received its name centuries ago, when tailors sat cross-legged all day with their feet rubbing on the ground, which led them developing a painful bump at the side of the little toe.
A Tailor's bunion is an enlargement of the head of the long bone behind the little toe. This produces a pressure area and callus at the bottom of the fifth toe.

Causes
Tailor's bunion is caused by inherited faulty mechanical structure of the foot. Constant pressure causes changes in the bony shape of the foot, resulting in the development of the enlargement. The fifth metatarsal bone starts to protrude outward, while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it. Sometimes a Tailor's bunion is an outgrowth of bone on the side of the fifth metatarsal head. Regardless of the cause, the symptoms of a Tailor's bunion are usually aggravated by wearing shoes that are too tight in the toe, producing constant rubbing and pressure.

Symptoms
The symptoms of tailor's bunions include redness, swelling, and pain at the outer side of the foot. These symptoms occur when wearing shoes that rub against the bump, irritating the soft tissues underneath the skin and producing inflammation. Constant rubbing and pressure on the skin forms a callus and the tissues under the skin also grow thicker. Both the thick callus and the thick soft tissues under it are irritated and painful.

Diagnosis
Tailor's bunion is easily diagnosed on physical examination.

However, x-rays may be ordered to help the podiatrist determine the cause and extent of the deformity and will help if surgery is necessary later.

Non-surgical treatment
Initial treatment for a Tailor's bunion begins with non-surgical therapies. Your podiatrist may select one or more of the following:
o Shoe modifications. Choose to wear shoes that have a wide toe box, and avoid those with pointed toes or high heels.
o Remove the callus. For pain relief, the podiatrist can also remove some of the built-up callus and hard skin in the area. This is an important step to prevent pain and even ulcers from developing at the site of the Tailor's bunion.
o Padding. Bunionette pads can be placed over the area to help reduce pain.
o Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), may help relieve the pain and inflammation.
o Icing. An ice pack may also be applied to reduce pain and inflammation.
o Injection therapy. Injections of corticosteroid may be used to treat the inflamed tissue around the joint.
o Orthotic devices. In some cases, custom orthotics devices may be provided by the foot and ankle surgeon.

Surgery
Surgery is often considered when the pain continues regardless of treatment efforts. Based on the extent of the deformity, a corrective surgical procedure will be selected. The podiatrist will take into consideration the extent of the deformity based on the x-ray findings, the age, the activity level, and other factors. Surgery usually involves removing the prominence of bone underneath the bunion to relieve pressure. Before deciding on the procedure extra bone is removed and the fifth toe and joint is straightened. The recovery time after surgery, will vary, depending on the procedure or procedures performed.

oFor more information, email me at foothealth242@gmail.com or visit www.foothealth.org or apma.org. To see a podiatrist, visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates on Albury Lane, telephone 394-5820.

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