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.
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Epidemiology
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.
Clinical presentation
Bunionettes are visible on clinical examination as an erythematous swelling overlying the 5th metatarsal head. They may be tender on palpation.
Pathology
Classification
Bunionettes are usually classified with the Coughlin classification, which uses radiographic criteria 3,4.
Radiographic features
Typically seen as a varus deformity at the 5th metatarsophalangeal joint. An increase in the fourth-fifth intermetatarsal angle may be seen 2.
Treatment and prognosis
Conservative management is the first line of treatment, with the use of wide-fitting footwear and orthotics. Surgical management involves osteotomy and resection.
History and etymology
In the premodern era, tailors used to suffer from 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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