Tailors Bunion

Tailor’s Bunion

A deformity of the fifth metatarsal position in which the head of the metatarsal head is abnormally prominent.

Also called –‘bunionette’
Originally thought to be due sitting cross legged, ie ‘tailors’

Clinical Features:
Prominence of the fifth metatarsal head.
Shearing between the osseous prominence and overlying soft tissues fixed by the shoe will result in a bursa – may be inflamed or have hyperkeratosis.

On x-ray the lateral side of the fifth metatarsal head appears prominent, but it is actually the plantar condyles of the head, due to the pronated position of the fifth ray.

Aetiology
Root et al (1977) identify 5 aetiological factors that can produce a tailor’s bunion:
Abnormal subtalar joint pronation of the foot
Any uncompensated varus position of the forefoot or rearfoot in a fully pronated foot
A congenital plantarflexed fifth ray
A congenital dorsiflexed fifth ray
Idiopathic

Pathomechanics
Abnormal subtalar joint pronation:
When this happens during late stance, the fifth ray becomes hypermobile, resulting in increased shearing between the metatarsal head and the shoe. This on its own will generally not cause a tailor’s bunion and needs the presence of other aetiological factors.

Uncompensated varus deformity:
This foot type will result in a hypermobile fifth ray and the metatarsal head will be forced into a dorsiflexed, abducted, and everted position – this prominent position, combined with shearing force will result in a tailor’s bunion.

Congenital plantarflexed fifth ray:
This will produce a tailor’s bunion if the foot pronates excessively. As ground reaction forces the fifth ray to dorsiflex to the same plane as the other metatarsals, it will also evert and abduct (this occurs due to the position of the axis of motion of the fifth ray).

Congenital dorsiflexed fifth ray
The fifth metatarsal head will be prominent dorsally, so when combined with shearing stress, a dorsal tailor’s bunion will result.

Treatment
Conservative:
Treat inflammation and debride lesions
Accommodative padding
Foot orthoses
Footwear advice
Footwear modifications

Surgical:
‘Lumpectomy’
Wedge osteotomies

 
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