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Bunionette is also called “Tailor’s Bunion”. It is a prominence usually at the lateral part of the fifth metatarsal head. Pain can result from the bursitis. Bursitis can happen because of rubbing of the fifth metatarsal head prominence against the shoes. The patient will have a widened forefoot and may have hyperkeratosis. This condition occurs more in women and could be bilateral. It can be diagnosed by weight-bearing AP view radiograph.

There are three types of bunionette (type decides the treatment):
1. The fifth metatarsal head is enlarged. It has normal alignment.

2. Lateral bowing of the diaphysis of the fifth metatarsal.

3. Widened four and five intermetatarsal (IM) angle. More than 8 degrees is pathologic.

Nonoperative treatment has a high success rate. Nonoperative treatments include anti-inflammatory medication or orthosis which is wearing proper shoes with a wider tow box and pad in the prominence area. Surgery is rarely needed. In Type I, you should do a resection of the lateral part of the fifth metatarsal head. In Type II, you should do distal metatarsal osteotomy. In Type III, when the intermetatarsal (IM) angle is more than 12 degrees, do oblique diaphyseal osteotomy. You sould avoid proximal osteotomy in the fifth metatarsal due to the possibility of interrupting the important blood supply. There is also a high rate of nonunion.

Nabil Ebraheim, MD

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