Tailor's bunion

What is a tailor's bunion, and how common is it?

A tailor's bunion (bunionette) is a bony lump on the outer side of the foot, at the base of the little toe¹. The fifth metatarsal (the long bone behind the little toe) pushes outwards while the little toe tilts inwards².

It's like a smaller version of the usual bunion at the big toe, and it's less common³. The lump can make your foot wider, so comfortable shoes are harder to find. The skin over it may thicken or blister, or the fluid-filled pad (bursa) over the lump can become inflamed and painful³.

Some people have no symptoms at all, and the lump is found by chance¹. If it isn't bothering you, it may not need any treatment.

What causes it, and who gets it?

The exact cause isn't known. It's likely a mix of the shape of the fifth metatarsal and an imbalance in the soft tissues at the front of the foot⁴. Foot shape that runs in families is believed to play a big role⁵. It's reported more often in women and in athletes¹.

Tight shoes are a contributing factor: they press on the joint, the bursa and the nerves around it, and can cause pain, thickened skin and inflammation³⁴.

Other things that may contribute include a past injury to the toe joint, very flexible joints, inflammatory arthritis, tight calf muscles, and some nerve and muscle conditions⁶. These are possible contributors, not measured risks.

What does it feel like, and how is it diagnosed?

You may notice a lump at the little toe joint, the little toe leaning towards the fourth toe, pain and swelling around the lump, and red, swollen or hard skin over it⁶. Most problems come from shoes rubbing, with a corn or callus on the outside of the joint⁷. People usually seek help once the skin over the lump becomes calloused or inflamed¹.

A podiatrist or doctor can diagnose it from your story, an examination of your foot, and usually weight-bearing X-rays (taken while you stand)¹. It helps to note which shoes bring on the pain, and where the rubbing, hard skin or swelling is.

What helps first?

Start with your shoes and the rubbing. Most people's pain eases with simple steps, though they don't change the size or shape of the lump⁵.

• Wide, deep shoes with a soft upper can mould around the lump⁶. Avoid high heels⁸ and tight or pointed shoes.
• Padding or a protective shield over the lump, or gel or silicone wedges between the toes, can cut down rubbing⁸. If the skin is broken or blistered, cover it with a plaster⁶.
• Callus and corn care: a podiatrist can remove hard skin and corns².
• Insoles (orthoses) may help, especially if your foot rolls inwards too much when you walk⁹.

These steps are the recommended starting point¹⁰, but it isn't clear yet how long the relief lasts.

What helps if that isn't enough?

Surgery is the main option. It's worth considering when pain and shoe problems don't respond to non-surgical care². It usually involves cutting and repositioning the fifth metatarsal and securing it with screws or plates, to reduce the lump and address any little toe deformity⁸.

Surgery can reduce pain and deformity, make shoes more comfortable and cut down callus². One common technique has a low complication rate and high satisfaction¹¹. Risks include joint stiffness, a little toe that floats or dislocates, a stress fracture, and the lump coming back².

If this sounds like you, ask your GP or podiatrist about referral to a foot and ankle surgeon. Ask which procedure suits your foot, and what recovery involves.

How long does it take, and can it come back?

Without surgery, pain usually eases once pressure on the lump is reduced, but the lump keeps its size and shape⁵. It isn't clear yet how long that takes, or whether footwear changes stop the lump growing. They do help keep pain down³, so keep wearing wide, deep, soft shoes and using padding even once the pain settles.

After surgery, the lump can come back. The most common problem is thickened skin returning under the ball of the foot¹¹. This is more of a risk if thick skin is your main complaint, so ask your surgeon about it¹¹.