A bunionette, also known as a tailor's bunion or metatarsus quintus valgus, is a bony prominence at the lateral 5th metatarsal head. It is the lateral counterpart of the more common bunion of the first metatarsophalangeal joint, and when they occur together (often with spreading of the other metatarsals), patients may be said to have a splayfoot.
They are thought to be caused by narrow/restrictive footwear. Some individuals may be predisposed to developing a bunionette due to an abnormal transverse metatarsal ligament, or an enlarged 5th metatarsal head.
Bunionettes are visible on clinical examination as an erythematous swelling overlying the 5th metatarsal head. They may be tender on palpation.
Bunionettes are usually classified with the Coughlin classification, which uses radiographic criteria 3,4.
Typically seen as a varus deformity at the 5th metatarsophalangeal joint. Increased angulation can also be present between the 4th and 5th metatarsals, e.g. a widening in the gap between the 4th and 5th metatarsal heads.
Treatment and prognosis
Conservative management is the first line of treatment, with use of wide-fitting footwear and orthotics. Surgical management involves osteotomy and resection.
History and etymology
In the premodern era, tailors used to suffer with this condition due to prolonged sitting in a cross-legged position, leading to increased pressure on the lateral aspect of the 5th metatarsal head against the floor.
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- 2. Cohen BE, Nicholson CW. Bunionette deformity. The Journal of the American Academy of Orthopaedic Surgeons. 15 (5): 300-7. Pubmed
- 3. Shofler DW, McKenna B, Huang J, Christman RA. Reproducibility and Reliability of the Radiographic Angles Used to Assess Tailor's Bunions. (2018) Journal of the American Podiatric Medical Association. 108 (3): 205-209. doi:10.7547/16-164 - Pubmed
- 4. The Bunionette Deformity: Overview and Classification. (2010) Techniques in Foot & Ankle Surgery. 9 (1): 2. doi:10.1097/BTF.0b013e3181d0e731