Tailor’s Bunion: The Surgical Approach

Tailors bunion, or Bunionette, is identical to the bunion most people are familiar with, but found on the base of the 5th toe instead of the 1st toe. It received its name due to the thought that tailors would sit cross legged causing the proverbial bump. Is a Tailors bunion a medical emergency? No. Does it hurt? Yes. You could say it is a quality of life emergency. Many physicians will choose non-surgical approaches as treatment, i.e. padding, wider shoe gear, shaving calluses. However, for those who are exhausted by the pain or simply dont like the look, there are surgical options for correction. The following is a guide as to what your physician will be examining when determining the type of correction for you.

When your physician takes x-rays of your foot, they will evaluate several parameters that will lead them to the proper surgical approach. So what is being evaluated? There are classification systems for everything in medicine. The most commonly accepted classification for a Tailors bunion is one described by Fallat and Buckholz. They described 4 types:

Type 1: a prominent, or enlarged, lateral portion of the 5th metatarsal head (arrow). With all bunion type deformities, it is the head of the metatarsal that is seen as the bump.

Type 2: lateral bowing of the distal (arrow), distal being toward the toes, of the metatarsal shaft. The bowing produces the bump seen externally. This is measured with an angle formed by the bisection of the 5th metatarsal head and a line drawn along the distal medial half of the metatarsal shaft. This angle is known as the Fallat and Buckholz angle (asterisk). This angle increases as bowing increases.

Type 3: increased intermetatarsal angle between the 4th and 5th metatarsals (asterisk). This increased angle causing the head of the 5th metatarsal to deviate laterally forming the bump.

Type 4: combination of types 2 and 3.

The surgical approach in correction is based on the type/severity of deformity present. A type 1 bunionette lends itself to the true bumpectomy, where the enlarged portion of the metatarsal head is simply removed and the edges smoothed down. A mild-moderate type 2 or 3 bunionette would best be corrected by removing the bump, followed by making a cut in the head of the metatarsal and shifting it medially, toward the big toe, and fixating with screws or k-wires. A substantial type 2, 3, or even 4 will be better corrected with a bone cut made in the shaft of the metatarsal, rather than the head. This provides the ability to correct a larger deformity.

There are multiple procedures that could be performed depending on physician preference. However, determining the level of deformity will guide the physician towards the proper category of surgical procedures. With this knowledge you should have a better understanding of why your physician chooses one type of procedure versus another. Knowledge is power and you have the power of your health.

Dr. Jeff Bowman of Houston Foot Specialists has performed more than 1,000 of these procedures and will be glad to go over it in detail with you. Contact Dr. Bowman at 713-467-8886 or check out his website for online appointments and more information www.houstonfootspecialists.com.

Category: Foot Problems

Tags: Bunion, foot pain, Foot Problems, Foot Surgery, Tailor's Bunion, Toe Pain, Toe Problems