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Figure. Anteroposterior radiograph of the left foot.
A 56-year-old woman presents to the office with pain in her left foot that has persisted for the past 2 months. She reports that the pain intensifies when she wears dress shoes but seems to improve when she walks barefoot. On physical examination, a skin callus identified at the fifth metatarsophalangeal (MTP) joint creates a lateral prominence. She has pain on palpation at the fifth MTP joint. Anteroposterior radiograph of the left foot is obtained (Figure).
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A bunionette is a painful prominence on the lateral fifth MTP joint. Bunionettes can develop at any age and are more common in women.1 A bunionette is often called a tailor’s bunion as tailors commonly sit with their legs crossed, which may put pressure on the lateral aspect of their foot.1
Common causes of a bunionette include compression of the forefoot, such as happens with tight-fitting shoes, and abnormal loading of the lateral aspect of the foot (causing lateral bending of the fifth MTP joint).2 Flat foot deformities and inflammatory disorders such as rheumatoid arthritis may also contribute to the development of a bunionette. As a bunionette deformity worsens, the fifth metatarsal deviates laterally while the proximal phalanx deviates medially, forming a varus deformity.1,2
A painful area of hyperkeratosis and pseudobursae can form over the lateral aspect of the fifth MTP joint. Other features found on physical examination include a widened forefoot and erythema over the bunionette.1,2
Treatment involves footwear with a wide toe box and padding around the prominent bunionette to relieve pressure on the area. Orthotics may be used if excessive pronation of the subtalar joint is found. Surgical options include resection of part, or all, of the metatarsal head and distal metatarsal osteotomy.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
References
1. Koti M, Maffulli N. Bunionette. J Bone Joint Surg Am. 2001;83(7):1076-1082.
2. Nestor BJ, Kitaoka HB, Ilstrup DM, Berquist TH, Bergmann AD. Radiologic anatomy of the painful bunionette. Foot Ankle. 1990;11(1):6-11.
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