Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

A bunionette deformity is an abnormal bony protuberance, or bump, on the outer (lateral) side of the fifth toe or metatarsophalangeal joint (MTPJ). This problem can start out as small and painless, but then become larger and more
Painful over time. When bunionettes become larger, it is usually because of growth of the protuberance, a curved shape to the fifth MTPJ, or both. The condition is sometimes called a tailor’s bunion. The first way that patients are treated for their bunionette is nonsurgically. This can include wearing different shoes that are roomier, padding the fifth toe, and using special or custom-made inserts in the shoe. All of these are designed to reduce the discomfort over the prominent fifth toe or MTPJ. If the bunionette’s symptoms do not improve with nonsurgical treatments, surgery may be needed. The goals of surgery are to decrease the fifth toe’s protuberance and deformity and to decrease pain.
If you have pain at your bunionette, if you cannot wear comfortable shoes because of the size of your bunionette, or if you continue to have problems after receiving nonsurgical treatment, surgery may be an option.

If surgery is needed, several different types are an option. The actual type of surgery to be performed depends on the shape of the fifth toe bones, type of bunionette and patients’ wishes.

1. If patients have a painful fifth toe protuberance without a bony growth, the surgery usually involves a removal of the painful soft tissue of the fifth toe. Specifically, what is removed from the outer fifth toe is the excess skin and the joint’s inflamed soft tissue or bursa.
2. Patients with a Type 1 bunionette deformity have a bony protuberance at the fifth MTPJ. During surgery, this bony growth is also removed. Some surgeons call this a bunionectomy.
3. Sometimes the bony protuberance is so big that the bones of the fifth toe need an osteotomy. With the bone cut, it is then moved inward to decrease its size (see X-rays above).
4. If patients have a curved shape to their fifth toe (Type 2 bunionette) or angle (Type 3 bunionette) between the fourth and fifth toes, then an osteotomy is often done. This osteotomy is done to straighten out the fifth toe.
5. If a bunionette deformity is treated with an osteotomy, the bone is often held straight with a steel wire, screw, or plate and screws, depending on the surgeon’s preference.

Full recovery after treatment of bunionettes is different based on the treatment. A three- to six-month period of nonsurgical treatment should be tried since many symptoms can improve this way.

Most surgical treatments need some period of foot protection in a surgical shoe, boot or splint. This time frame is usually between three to 12 weeks. The specific time for recovery after surgery depends on the type of surgery. You will be asked to elevate your foot above the level of your chest for the first weeks after surgery. You may also be asked to use crutches or a walker depending on your activity level. Your stitches are usually taken out two to three weeks after surgery. You will be asked to not soak your foot or get the surgical area wet until your stitches are out. Your doctor may ask you to do certain knee and ankle exercises at home after surgery. This can help maintain your joint motion and flexibility. If your doctor thinks that you need formal physical therapy after surgery, he or she will discuss that with you. Swelling is the last thing to improve for most patients after bunionette surgery. It can take three to 12 months for your foot’s swelling to completely improve after surgery. Potential complications after bunionette surgery are rare. Possible problems include bleeding from the wound, injured nerves around the fifth toe, poor wound healing or bone healing if an osteotomy is done, and the possibility of the bunionette coming back.