✅ Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified podiatrist specializing in foot & ankle surgery. View credentials.
What Is a Bunionette (Tailor’s Bunion)?
A bunionette—also called a tailor’s bunion—is a bony prominence on the outer side of the foot at the base of the fifth (small) toe, at the fifth metatarsophalangeal (MTP) joint. It is the lateral counterpart to the medial bunion (hallux valgus), and while less common, it causes similar symptoms: pain, redness, callus formation, and difficulty with footwear. The historical name “tailor’s bunion” comes from cross-legged sitting posture historically used by tailors, which places pressure on the outer foot.
Written & Reviewed By
Dr. Tom Biernacki, DPM
Board-Certified Podiatric Physician & Surgeon · Michigan Foot Doctors · Balance Foot & Ankle
Serving Howell, Brighton, Hartland, Fowlerville, Pinckney, South Lyon & Milford, MI
Bunionettes have three anatomic subtypes based on the source of the prominence: Type 1 is a lateral condylar enlargement of the fifth metatarsal head; Type 2 is lateral bowing of the metatarsal shaft with a normal head; Type 3 is an increased fourth-fifth intermetatarsal angle—the fifth metatarsal angles outward relative to the fourth, creating lateral prominence. The type determines the appropriate surgical correction when conservative care fails. Weight-bearing X-rays with measurement of the fourth-fifth intermetatarsal angle (normal under 9°) and fifth metatarsophalangeal angle (normal under 16°) quantify the deformity.
Symptoms and Causes
The primary symptom is pain and irritation at the outer fifth metatarsal head from shoe friction. The overlying skin typically develops a callus or bursitis (fluid-filled sac). Pain is worst with narrow shoes and footwear with tight lateral counters, and relieves with barefoot walking or wide shoes. The fifth toe may deviate medially (toward the 4th toe) in more advanced cases, creating a structural hallux valgus-type deformity laterally. Associated 5th toe corns from toe crowding and 4th web space skin irritation are common.
The etiology is multifactorial: inherited foot structure (wide fifth metatarsal head, increased intermetatarsal angle), tight or narrow footwear that compresses the forefoot, and biomechanical factors that increase lateral forefoot loading. Unlike hallux valgus, there is no strong association with high-heeled footwear for bunionettes—the deformity reflects structural anatomy more than shoe choice alone.
Conservative Treatment
Conservative management follows the same principles as medial bunion treatment: address the footwear environment first. Wide-toe-box shoes eliminate the source of friction and pressure on the lateral prominence. Bunionette pads (donut-shaped gel or felt pads) protect the bump from shoe counter pressure. Stretching the shoe laterally over the prominence (cobbler modification) accommodates the deformity within existing footwear. Custom orthotics with appropriate lateral offloading and a 5th metatarsal relief can redistribute pressure away from the prominence.
Corticosteroid injection into the overlying bursa provides temporary relief of bursitis-related pain. Like medial bunions, conservative care does not correct the structural deformity—it manages symptoms. Most patients with bunionettes achieve adequate pain control with wide-toe-box footwear and pads without requiring surgery. Surgery is reserved for patients with significant pain persisting despite appropriate conservative measures.
Surgical Correction
Surgery for bunionette is performed when conservative measures fail to adequately control pain. Surgical options depend on the anatomic type: condylectomy (removal of the lateral condylar prominence)—appropriate for Type 1 with a large lateral metatarsal head; distal metatarsal osteotomy (cutting and realigning the metatarsal head)—most commonly a distal chevron or closing wedge osteotomy for Type 2 and 3; and diaphyseal osteotomy (correcting the shaft-level bowing) for Type 2. In all types, the key is correcting the structural deformity that produces the prominence, not simply shaving the bump (which has high recurrence rates).
Recovery after bunionette surgery parallels medial bunion recovery: weight-bearing in a surgical sandal begins immediately, transition to regular shoes at 4–6 weeks, and return to athletic footwear at 6–8 weeks. Swelling may persist for several months. Patient satisfaction rates after appropriately selected bunionette surgery are approximately 80–85%.
Frequently Asked Questions
What is the difference between a bunion and a bunionette?
A bunion (hallux valgus) affects the first (great) toe side of the foot—the prominent medial bump at the base of the big toe, with the big toe deviating toward the second toe. A bunionette affects the fifth (small) toe side—the prominent lateral bump at the base of the little toe, sometimes with the little toe angling toward the fourth. They are mirror-image deformities on opposite sides of the foot and can occur together (a foot with both a medial bunion and a lateral bunionette). The treatment approach is similar for both—conservative footwear modification first, surgery when conservative care fails—though the specific surgical techniques differ based on anatomy.
Can bunionettes go away on their own?
No—the structural bony deformity of a bunionette does not resolve without surgery. The prominence reflects the anatomy of the fifth metatarsal (enlarged lateral condyle, angular shaft, or widened intermetatarsal angle), which cannot be altered by stretches, splints, or conservative measures. What conservative care can do is eliminate the pain caused by the prominence through footwear modification, pads, and offloading—many patients achieve complete pain relief without ever needing surgery by simply wearing appropriate wide shoes. The deformity itself remains, but it becomes asymptomatic. If pain is controlled and the foot functions normally in appropriate footwear, surgery is not necessary.
Is bunionette surgery done at the same time as bunion surgery?
Yes—when both a medial bunion and a lateral bunionette are symptomatic and require surgical correction, they can be performed in the same surgical session. Simultaneous correction avoids two separate procedures and recovery periods. The primary practical consideration is that combined medial and lateral forefoot osteotomies require careful postoperative weight-bearing management—most surgeons use a surgical sandal with weight-bearing on the midfoot and heel, avoiding pressure on both sides of the operated foot. Recovery is somewhat longer than for a single procedure, but the overall timeline is shorter than sequential surgeries.
Medical References & Sources
- PubMed Research — Bunionette Surgical Outcomes
- American Orthopaedic Foot & Ankle Society — Bunionette
- PubMed Research — Bunionette Classification and Treatment
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He evaluates and treats bunionettes with footwear guidance, orthotics, and surgical correction including fifth metatarsal osteotomy when conservative care is insufficient.
Dr. Tom’s Recommended Products for Bunions
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
These are products I personally use and recommend to my patients at Balance Foot & Ankle.
- Correct Toes Toe Spacers — Silicone spacers realign toes to natural position — reduces bunion pain and slows deformity progression
- NatraCure Gel Toe Separator and Bunion Guard — Gel cushion with integrated spacer — immediate pain relief for bunion friction against shoe box
- New Balance 928v3 Walking Shoe — Wide toe box with ROLLBAR stability — gives the bunion room while controlling overpronation that worsens deviation
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
Dr. Tom’s Recommended Insoles
PowerStep is the brand I prescribe most — medical-grade OTC support without the custom orthotic price tag.
- PowerStep Pinnacle Insoles — The OTC orthotic I recommend most — medical-grade arch support at a fraction of custom orthotic cost. Works in most shoes.
- PowerStep Maxx Insoles — For severe arch pain or flat feet — maximum correction and support when Pinnacle isn’t enough.
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
In-Office Treatment Available
When conservative bunion care isn’t enough, Dr. Tom offers advanced treatment including custom orthotics to slow progression and, when indicated, minimally invasive bunion surgery with fast recovery. Most patients return to normal shoes in 8–12 weeks.
Frequently Asked Questions
Q: What causes a tailor’s bunion?
A: A prominent or outward-flaring 5th metatarsal head, often hereditary. Narrow shoes worsen the bump and cause bursitis (fluid-filled sac) and soft-tissue inflammation.
Q: What shoes are best for tailor’s bunions?
A: Wide toe box with at least ½” clearance at the 5th toe, soft upper material, and low heel. Stretchy athletic uppers or extra-wide width options work best. Avoid anything with seams over the bump.
Q: Can a bunionette be treated without surgery?
A: Yes—padding, shoe modifications, cortisone for acute flares, and custom orthotics to reduce lateral forefoot pressure address 70-80% of cases without surgery.
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Q: What does tailor’s bunion surgery involve?
A: 5th metatarsal osteotomy (bone cut and realignment)—outpatient, 45-minute procedure. Recovery: weight-bearing in surgical shoe 6-8 weeks. Excellent cosmetic and functional results.
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Medically Reviewed by: Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists
Bunionette (Tailor’s Bunion) Causing Pain? We Can Help
A bunionette is a painful bony bump on the outside of the little toe. Our podiatrists offer padding, orthotics, and minimally invasive surgical correction when needed.
Clinical References
- Coughlin MJ. Treatment of bunionette deformity with longitudinal diaphyseal osteotomy with distal soft tissue repair. Foot Ankle. 1991;11(4):195-203.
- Kitaoka HB, Holiday AD Jr. Lateral condylar resection for bunionette. Clin Orthop Relat Res. 1992;(278):183-189.
- Legenstein R et al. Oblique versus transverse diaphyseal osteotomy of the fifth metatarsal for bunionette correction. Foot Ankle Int. 2007;28(4):424-430.
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
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