A bunionette is a prominent deformity at the base of the little toe. This can be painful, especially if it rubs against a tight fitting shoe. A bunionette occurs when the bone of the midfoot (metatarsal) angles out and the little toe (phalanx) angles in, resulting in a bony prominence. Non-surgical treatment is often successful and includes: wearing proper shoes with space to accommodate the bump; correcting the little toe deformity with a toe spacer; or padding the prominence to prevent irritation. Surgery is an option when non-operative treatment is unsuccessful.
A Bunionette is a deformity at the base of the fifth or little toe (Figures 1 & 2), which tends to occur gradually over time. Patients with bunionette deformities experience localized pain on the outside aspect of the base of the fifth toe.
Physical examination will show a deformity of the fifth toe with a prominence on the outside at the base. There can be swelling in this area representing a bursa, which is a fluid-filled sac. The fifth toe itself usually has a normal range of motion. The sensation and blood supply of the foot is typically normal. Sometimes, patients also have a bunion of the big toe.
Standing plain x-rays show the bony alignment that is responsible for the observed deformity. There is usually an angular deformity at the fifth metatarsophalangeal joint, which corresponds to the base of the fifth toe. In some patients, the problem is a metatarsal bone (the long bones of the mid-foot) that angles outward as well as the toe leaning inward.
Most of the cases of bunionette deformity can be managed nonoperatively. Non-operative treatment includes:
In a small percentage of patients, operative treatment will be beneficial. Surgery should only be considered after nonoperative management has failed. The type of operative treatment is dependent upon the actual deformity. Operative options for treating bunionette deformities include:
Potential post-operative complications include general surgical complications such as:
Specific complications associated with a bunionette correction include: