Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Bunionette (Tailor’s Bunion): Fifth Toe Bump Causes &# relates to bunions — typically caused by genetics + footwear pressure. Most patients improve in 6-8 weeks recovery if surgical with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
▶ Watch
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
A bunionette — also called a tailor’s bunion — is a bony prominence on the lateral (outer) aspect of the foot at the fifth metatarsal head, the joint at the base of the little toe. It is the mirror image of a hallux valgus bunion at the first toe, and like its medial counterpart, it is a structural deformity that progressively worsens without intervention. The name “tailor’s bunion” derives from the historical practice of tailors sitting cross-legged, placing chronic pressure on the lateral fifth metatarsal head.
Anatomy and Causes
The fifth metatarsal angle (the angle between the fourth and fifth metatarsals — 4-5 IMA) is the primary radiographic measure. In a normal foot, the 4-5 IMA is less than 8–9°. Three structural subtypes of bunionette exist:
- Type I: Enlarged fifth metatarsal head (lateral eminence hypertrophy) with normal 4-5 IMA
- Type II: Curved fifth metatarsal shaft with normal head size
- Type III: Increased 4-5 intermetatarsal angle (most common) — lateral deviation of the fifth metatarsal shaft and head
Bunionettes develop from a combination of genetic predisposition (hypermobility of the fifth tarsometatarsal joint, structural foot type) and footwear factors — particularly narrow toe boxes that compress the fifth toe inward.
Symptoms
The primary symptom is pain over the lateral fifth metatarsal head — worse in shoes, particularly any footwear with a tight lateral counter. A visible bony prominence, callus or bursal swelling over the eminence, redness, and occasional skin breakdown over the most prominent aspect are common findings. The fifth toe itself may angle medially (toward the fourth toe), compounding the crowding.
Conservative Treatment
Conservative management reliably provides symptom relief for most patients:
- Wide toe box footwear: The single most effective intervention — eliminating lateral fifth metatarsal head pressure by choosing shoes with an accommodating last
- Silicone fifth toe spacers and lateral padding: Reduce direct pressure and friction at the eminence
- Custom orthotics: Orthotics with a lateral flare or lateral column offloading reduce fifth metatarsal head pressure during gait
- Bursa injection: Corticosteroid injection into an inflamed bursal sac over the fifth metatarsal head reduces acute inflammation and swelling
Surgical Treatment
Surgical correction is considered when pain persists despite at least 3–6 months of appropriate conservative care. The surgical approach is selected based on the structural subtype:
Lateral condylectomy (shaving the eminence): Appropriate for Type I bunionettes with an enlarged head but normal 4-5 IMA. Simple outpatient procedure; rapid recovery. High recurrence rate if the structural etiology involves increased IMA rather than isolated head hypertrophy.
Fifth metatarsal osteotomy: Required for Type III bunionettes with increased 4-5 IMA, and Type II curved shaft deformities. Several osteotomy types are used:
- Distal chevron osteotomy: Lateral translational osteotomy at the fifth metatarsal head — most commonly performed for mild-to-moderate Type III deformity
- Scarf or oblique shaft osteotomy: Mid-shaft correction for larger IMA; more powerful correction but technically more demanding
- Proximal closing wedge osteotomy: Most powerful IMA correction; reserved for large deformities (4-5 IMA > 12°)
Most bunionette surgeries are outpatient procedures; patients walk in a surgical shoe immediately and return to regular footwear at 4–8 weeks.
Painful Little Toe Bump? Get an Evaluation.
Dr. Biernacki at Balance Foot & Ankle evaluates bunionettes with weight-bearing X-rays and recommends the appropriate conservative or surgical approach. Same-week appointments at Bloomfield Hills and Howell.
📞 (810) 206-1402 | Request an Appointment →
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentIn Our Clinic
In our clinic, bunion patients come in at two very different stages. The first group is women in their 30s and 40s noticing a small bump and seeking nonsurgical slowing tactics — wide toe box shoes, bunion splints at night, custom orthotics to redistribute load away from the first MTP. The second group is patients in their 50s+ who can no longer find shoes that fit and are asking, honestly, about surgery. Our standard workup includes weight-bearing X-rays to measure the intermetatarsal angle and the HVA. Patients with an IMA under 13° usually do well conservatively; 13°+ often benefits from a surgical plan.
More Podiatrist-Recommended Bunion Essentials
Bunion-Friendly Stability Shoe
- THIS MEN’S SHOE IS FOR: The Adrenaline GTS 25 is perfect for runners and walkers seeking reliable support and a smooth ride. Featuring holistic GuideRails for Go-To Support and soft, dynamic premium nitrogen-infused DNA LOFT v3 cushioning, it delivers distraction-free comfort mile after mile. This Brooks Adrenaline GTS 25 is a certified PDAC A5500 Diabetic shoe and has been granted the APMA Seal of Acceptance. Predecessor: Adrenaline GTS 24.
- GUIDERAILS HOLISTIC SUPPORT SYSTEM: Our innovative technology - known as “GTS” for “Go-To Support” - supports your body in its natural motion path while keeping excess movement in check.
- SOFT & DYNAMIC CUSHIONING: Even more premium nitrogen-infused DNA Loft v3 cushioning delivers lightweight softness, and feel-good comfort mile after mile.
- TRUSTED FIT: The breathable engineered mesh upper and flat-knit collar offer a secure, comfortable fit, providing both structure and flexibility to accommodate natural movement during active use.
- SMOOTH TRANSITIONS: The specially designed outsole and midsole work together to promote seamless transitions, ensuring comfort and support for every step, so you can stay active longer.
Brooks Adrenaline GTS 25 — wide toe box reduces bunion pressure.
Wide-Toe-Box Walking Shoe
- FuelCell foam delivers a propulsive feel to help drive you forward
- ENCAP midsole cushioning combines lightweight foam with a durable polyurethane rim to deliver all-day support
- Reflective accents designed to catch the light
- TPU back tab
- New Balance MADE contains a domestic value of 70% or more. MADE makes up a limited portion of New Balance’s US sales.
New Balance 990v6 — roomy forefoot accommodates bunions and reduces rubbing.
Orthotic Insole
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
- The PowerStep Pinnacle arch support inserts for men & women can be worn in a variety of shoe types such as; athletic, walking, running, work & some casual shoes. Orthotic Inserts are ordered by shoe size, no trimming required.
- Made in the USA & backed by a 30-day money-back guarantee. PowerStep orthotic inserts for men & women are designed for shoes where the factory insole can be removed. HSA & FSA Eligible
PowerStep arch support — realigns foot mechanics that drive bunion progression.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
A bunion is a progressive joint deformity — padding and splints reduce pain but don’t reverse the bone shift. If the big toe angle is worsening, shoes no longer fit, or pain is disrupting sleep or activity, schedule a consult at Balance Foot & Ankle. Our surgeons perform minimally-invasive bunion correction with faster recovery than traditional osteotomy. We’ll review X-rays with you and explain exactly what the joint needs.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
In-Office Treatment at Balance Foot & Ankle
When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Hammertoe Correction Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
Pros & Cons of Conservative Care for bunions
Advantages
- ✓ Surgery often avoidable
- ✓ Wide-toe-box shoes reduce pain
- ✓ Custom orthotics help
Considerations
- ✗ Genetic predisposition
- ✗ Will worsen over time
- ✗ Surgery 6-8 wks recovery
Dr. Tom’s Recommended Products for bunions
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Birkenstock Boston (Bunion-friendly) Dr. Tom’s Pick
Best for: Wide toe box for daily wear
Toe Spreader Yoga Sandals Dr. Tom’s Pick
Best for: Daytime toe spacer footwear
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
Recommended Products from Dr. Tom