What are they?
Like a bunion is a prominence on the big toe, a bunionette is a prominence on the little toe which can be called a tailors bunion. There is a deformity involving the long bone (metatarsal) of the little toe deviating away from the fourth toe metatarsal. This causes the soft tissues to work in a different way and results in the end of the little toe turning towards the fourth toe. This results in the affected joint rubbing against shoes and causing inflammation.
Why do they happen?
This is not fully understood however there is an association with tight foot wear, genetics/family history and other foot conditions such as bunions. With the wider forefoot there Is abnormal pressure on the toe joint, which can be exacerbated by wearing shoes with a tight
Pain is often associated with wearing foot wear that has a narrow toe box and is relieved when shoes are removed. With progression you may develop pain under the ball of the smaller toes or pain from deformities caused by the toes squashing against each other.
Changing foot wear to a soft and wider shoe to give the foot space, as well as a smaller heel can be of help.
Over-the-counter bunionette pads and spacers can be used to help with caution, as they can make finding appropriate foot wear more challenging because they widen the foot.
The majority of bunionette deformities can be managed surgically by breaking the long bone (metatarsal osteotomy) of the little toe and re-positioning this to correct the deformity. This bone shift of the metatarsal is held by a small screw. This procedure can be performed through a small incision on the side of the foot which is not visible from the top and fades with time.
Risks of Surgery
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, non-union, under correction and over correction.
Your foot will be in bandaging and a surgical shoe will be provided to allow you to weight-bear whilst protecting the foot. You will be provided with crutches for support. Elevation, as much as possible, is important in the first few weeks. The bandaging will come down at 2 weeks and dressings changed. The surgical shoe will be required for weightbearing for approximately 5-6 weeks. Swelling can be expected to be present for up to 6 months, particularly in the evenings.
With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 2 weeks is satisfactory. Otherwise, return to work should be expected after 6-8 weeks.