Tailor’s Burnion (Bunionette)
TAILOR’S BUNION (BUNIONETTE)
Description
Enlargement of, or prominence of, the 5th metatarsal head
Evaluation
IM Angle
Two Methods
1. Traditional method
The angle between the bisection of the 4th metatarsal and the bisection of the 5th metatarsal
Average normal value is 7°; higher values (8° to 10°) indicate an abnormality.
2. Fallat and Buckholz
The angle between the bisection of the 4th metatarsal and the medial cortical margin of the proximal portion of the 5th metatarsal
Average normal value is 7°; higher values (8° to 10°) indicate an abnormality.
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Lateral Deviation Angle
Bisection of the 5th metatarsal head and neck in relation to the medial cortical margin of the proximal portion of shaft
Average normal value is 3°; higher values (8°) indicate an abnormality.
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Classification
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Causes
Enlarged 5th metatarsal head or hypertrophied plantar condyles
Lateral bowing of the 5th metatarsal shaft
Increased 4th IM angle
Biomechanical
Cavus foot
Uncompensated rearfoot varus
Uncompensated forefoot varus
Splay foot
Metatarsus adductus
Forefoot valgus
Treatment
Conservative treatment
Padding
Wider shoes
NSAIDs
Steroid injections
Reduce callus
Surgical treatment
Exostoses
Davis
Removal of the lateral eminence (reverse Silver)
Dickson and Dively
Same as Davis but includes removal of an inflamed bursa
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DeVries
Technically, it is the removal of the lateral plantar condyle. Because the 5th metatarsal is often rotated medially, the lateral plantar condyle is often the most lateral structure, thus making the procedure the same as the Davis.
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