summary Bunionette Deformities, commonly called tailor's bunion, are prominences on the lateral aspect of the 5th metatarsal head that most commonly occur as a result of compression of the forefoot. Diagnosis is made clinically with presence of a prominence on the lateral aspect of the 5th metatarsal head, often associated with pain and callus formation. Treatment can be nonoperative with shoe modifications for mild and minimally symptomatic cases. Surgical management is indicated for progressive deformity and difficulty with shoe wear Epidemiology Demographics commonly seen in adolescents and adults 2-4x more common in women often bilateral deformities Etiology Pathophysiology mechanism of disease extrinsic causes login to view 2 more bullets intrinsic causes login to view 3 more bullets pathoanatomy boney prominence +/- bursitis over lateral aspect of 5th metatarsal head increased 4-5 intermetatarsal angle (normal 6.5-8 degrees) increased lateral deviation angle (normal 0-7 degrees) increased width of MT head (normal <13mm) lateral bowing of the 5th metatarsal bone Associated conditions varus MTP joint pes planus Classification Bunionette Deformity Classification Type I Enlarged 5th MT head or lateral exostosis Type II Congenital bow of 5th MT, normal 4-5 IMA Type III Increased 4-5 IMA (most common) Presentation History effect on activities and employment Symptoms cosmetic deformity medial deviation of 5th toe prominence of the 5th metatarsal head pain lateral bunion plantar callus worse with constrictive shoe wear Physical exam inspection plantar or lateral hyperkeratosis widened forefoot erythema and swollen 5th bunion check shoe wear motion often painless passive ROM of 5th MTP joint Imaging Radiographs recommended views standard weight-bearing films, dorsoplantar, lateral & oblique films characteristic findings increased 4-5 IMA (normal 6.5-8 degrees) increased lateral deviation angle (normal 0-7 degrees) increased width of MT head (normal <13mm) CT scan indications ancillary studies rarely required may be used if there is associated trauma or malignancy Treatment Nonoperative NSAIDS, shoe wear modification, orthotics, keratosis padding, callous shaving indications login to view 2 more bullets techniques login to view 3 more bullets outcomes login to view 1 more bullet Operative lateral condylectomy indications login to view 1 more bullet technique login to view 2 more bullets outcome login to view 1 more bullet distal metatarsal osteotomy indications login to view 1 more bullet technique login to view 7 more bullets outcomes login to view 1 more bullet oblique diaphyseal rotational osteotomy indications login to view 1 more bullet technique login to view 3 more bullets outcomes login to view 1 more bullet metatarsal head resection indications login to view 2 more bullets Complications Recurrence is the most common complication with condylectomy alone Transfer metatarsalgia seen with isolated metatarsal head resection Claw toe