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• W2047007827 abstract "This clinical practice guideline (CPG) is based upon consensus of current clinical practice and review of the clinical literature. The guideline was developed by the Clinical Practice Guideline Forefoot Disorders Panel of the American College of Foot and Ankle Surgeons. The guideline and references annotate each node of the corresponding pathways. Tailor's bunion (also called bunionette) involves deformity of the fifth metatarsophalangeal joint (MPJ), much like a bunion that occurs medially. Although tailor's bunion typically involves deformity with lateral prominence of the fifth metatarsal head, both lateral and plantar clinical pathology will be discussed in this document. Numerous factors can contribute to the development of a tailor's bunion. Structural causes include a prominent lateral condyle, a plantarflexed fifth metatarsal, a splay foot deformity, lateral bowing of the fifth metatarsal, or a combination of these deformities (1Fallat L.M. Buckholz J. An analysis of the tailor's bunion by radiographic and anatomical display.J Am Podiatry Assoc. 1980; 70: 597-603Crossref PubMed Scopus (54) Google Scholar, 2Nestor B.J. Kitaoka H.B. Ilstrup D.M. Berquist T.H. Bergmann A.D. Radiologic anatomy of the painful bunionette.Foot Ankle. 1990; 11: 6-11Crossref PubMed Scopus (66) Google Scholar, 3Steinke M.S. Boll K.L. Hohmann-Thomasen metatarsal osteotomy for tailor's bunion (bunionette).J Bone Joint Surg Am. 1989; 71: 423-426PubMed Google Scholar, 4Yancey Jr, H.A. Congenital lateral bowing of the fifth metatarsal Report of 2 cases and operative treatment.Clin Orthop Relat Res. 1969; 62: 203-205Crossref PubMed Google Scholar, 5Frankel J.P. Turf R.M. King B.A. Tailor's bunion: clinical evaluation and correction by distal metaphyseal osteotomy with cortical screw fixation.J Foot Surg. 1989; 28: 237-243PubMed Google Scholar). In addition, there may be hypertrophy of the soft tissues over the lateral aspect of the metatarsal head (6Buchbinder I.J. DRATO procedure for tailor's bunion.J Foot Surg. 1982; 21: 177-180PubMed Google Scholar). Other contributing factors may include a varus fifth toe, hallux valgus with abnormal pronation of the fifth metatarsal, hindfoot varus, and flatfoot (7Diebold P.F. Bejjani F.J. Basal osteotomy of the fifth metatarsal with intermetatarsal pinning: a new approach to tailor's bunion.Foot Ankle. 1987; 8: 40-45Crossref PubMed Scopus (32) Google Scholar). Tailor's bunion is seen most commonly in adolescents and adults. It has been reported that the mean age of presentation of tailor's bunion is 28 years (range, 16–57 years) (8Steinke M.S. Boll K.L. Hohmann-Thomasen metatarsal osteotomy for tailor's bunion (bunionette).J Bone Joint Surg Am. 1989; 71: 423-426PubMed Google Scholar), with a female-to-male ratio greater than 2:1 (1Fallat L.M. Buckholz J. An analysis of the tailor's bunion by radiographic and anatomical display.J Am Podiatry Assoc. 1980; 70: 597-603Crossref PubMed Scopus (54) Google Scholar). The patient with a tailor's bunion may or may not have pain related to the deformity. Patients who have symptoms may complain that they are exacerbated by footwear, as the prominence of the fifth metatarsal head results in increased pressure from shoes, leading to inflammation and pain. There also may be a history of localized swelling and/or callus formation. The clinical examination of a patient with a tailor's bunion will reveal a lateral or plantar-lateral prominence of the fifth metatarsal head (Fig. 1). Tenderness on palpation of the lateral and/or plantar-lateral fifth metatarsal head may be associated with an overlying adventitial bursa or hyperkeratotic lesion. Adduction or adductovarus deformity of the fifth toe may be present. Standard weightbearing foot radiographs to evaluate tailor's bunion include anterior-posterior, oblique, and lateral views. An increase in the fourth and fifth intermetatarsal angle usually is present (Fig. 2). The angle between the fourth and fifth metatarsal has been reported to range from 14.4° to 0.6° (average and mean values: 7.1° and 7.2°, respectively) among a standardized asymptomatic patient population (9Thomas J.T. Kunkel M.W. Lopez R. Sparks D. Radiographic values of the adult foot in a standardized population.J Foot Ankle Surg. 2006; 45: 3-12Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar). Bowing of the fifth metatarsal also may be revealed on radiographs. The lateral deviation angle describes the degree of lateral bowing that usually occurs at the distal third of the shaft of the fifth metatarsal. The mean normal value of this angle is 2.64° (range: 0°-7°) in patients without tailor's bunion and 8° in patients with this deformity (1Fallat L.M. Buckholz J. An analysis of the tailor's bunion by radiographic and anatomical display.J Am Podiatry Assoc. 1980; 70: 597-603Crossref PubMed Scopus (54) Google Scholar). Radiographs also may reveal a lateral exostosis of the fifth metatarsal head and/or significant adduction (or adductovarus) deformity of the fifth toe. Ancillary studies rarely are necessary to evaluate a tailor's bunion deformity. When indicated, ancillary studies may include magnetic resonance imaging (MRI), computed tomography (CT), and technetium bone scan (10Fallat L.M. Pathology of the fifth ray, including the tailor's bunion deformity.Clin Podiatr Med Surg. 1990; 7: 689-715PubMed Google Scholar, 11Karasick D. Preoperative assessment of symptomatic bunionette deformity: radiologic findings.Am J Roentgenol. 1995; 164: 147-149Crossref PubMed Scopus (9) Google Scholar). The diagnosis of tailor's bunion is predominantly a clinical one. However, radiographic findings, in particular, may be very helpful in the assessment of the exact nature of the deformity and contributory structural pathology. The asymptomatic patient with a tailor's bunion deformity should be provided with patient education addressing the etiology of the condition and prevention of future symptoms. In particular, the patient should be given recommendations regarding proper footwear. Nonsurgical treatment of tailor's bunion deformity is centered on alleviating pressure and irritation over the fifth metatarsal head. This may be accomplished by footwear modifications and/or padding as well as debridement of associated hyperkeratotic lesions (Fig. 3). If an inflamed bursa is present, injection therapy may be indicated. Orthoses and padded insoles also may be beneficial in offloading the symptomatic area or in treating associated hindfoot varus or flatfoot deformity. Anti-inflammatory medication also may be used (12Ajis A. Koti M. Maffulli N. Tailor's bunion: a review.J Foot Ankle Surg. 2005; 44: 236-245Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar). Surgical treatment is indicated for patients who have failed nonsurgical care and patients who are not candidates for nonsurgical care. The goal of surgical treatment is to decrease the prominence of the fifth metatarsal laterally. Selection of the surgical procedure is based on the physical evaluation and radiographic assessment. Surgical correction to alleviate the pain at the bone prominence varies from exostectomy (Fig. 4) to differing types of osteotomies (3Steinke M.S. Boll K.L. Hohmann-Thomasen metatarsal osteotomy for tailor's bunion (bunionette).J Bone Joint Surg Am. 1989; 71: 423-426PubMed Google Scholar, 13Kitaoka H.B. Holiday Jr, A.D. Lateral condylar resection for bunionette.Clin Orthop Relat Res. 1992; 278: 183-192PubMed Google Scholar, 14Koti M. Maffulli N. Bunionette.J Bone Joint Surg Am. 2001; 83: 1076-1082PubMed Google Scholar, 15Roukis T.S. The tailor's bunionette deformity: a field guide to surgical correction.Clin Podiatr Med Surg. 2005; 22 (vi.): 223-245Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 16Hatch D. Long oblique distal osteotomy of the fifth metatarsal for correction of tailor's bunion: a retrospective review.J Foot Ankle Surg. 2003; 42: 247PubMed Google Scholar, 17Friend G. Grace K. Stone H.A. L-osteotomy with absorbable fixation for correction of tailor's bunion.J Foot Ankle Surg. 1993; 32: 14-19PubMed Google Scholar, 18Catanzariti A.R. Friedman C. DiStazio J. Oblique osteotomy of the fifth metatarsal: a five year review.J Foot Surg. 1988; 27: 316-320PubMed Google Scholar, 19Hansson G. Sliding osteotomy for tailor's bunion: brief report.J Bone Joint Surg Br. 1989; 71: 324PubMed Google Scholar, 20London B.P. Stern S.F. Quist M.A. Lee R.K. Picklesimer E.K. Long oblique distal osteotomy of the fifth metatarsal for correction of tailor's bunion: a retrospective review.J Foot Ankle Surg. 2003; 42: 36-42Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 21Zvijac J.E. Janecki C.J. Freeling R.M. Distal oblique osteotomy for tailor's bunion.Foot Ankle. 1991; 12: 171-175Crossref PubMed Scopus (31) Google Scholar, 22Weitzel S. Trnka H.J. Petroutsas J. Transverse medial slide osteotomy for bunionette deformity: long-term results.Foot Ankle Int. 2007; 28: 794-798Crossref PubMed Scopus (29) Google Scholar, 23Diebold P.F. Basal osteotomy of the fifth metatarsal for the bunionette.Foot Ankle. 1991; 12: 74-79Crossref PubMed Scopus (32) Google Scholar) (Fig. 5). Resection of the fifth metatarsal head for treatment of tailor's bunion generally is indicated for salvage conditions or in the presence of unreconstructable deformities (12Ajis A. Koti M. Maffulli N. Tailor's bunion: a review.J Foot Ankle Surg. 2005; 44: 236-245Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 24Kitaoka H.B. Holiday Jr, A.D. Metatarsal head resection for bunionette: long-term follow-up.Foot Ankle. 1991; 11: 345-349Crossref PubMed Scopus (48) Google Scholar) (Fig. 6).FIGURE 5(A) Tailor's bunion deformity generally is addressed with some type of osteotomy. (B) This illustrates a distal type of medial displacement osteotomy at 2 weeks postsurgery and (C) at 3 months postsurgery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)FIGURE 6This patient with an undercorrected adult clubfoot presented with a plantar lateral skin lesion and pain. Shown are presurgical (A) dorsoplantar and (B) lateral radiographs. (C) This dorsoplantar radiograph illustrates fifth metatarsal head resection and stabilization of the fifth ray with a kirschner wire.View Large Image Figure ViewerDownload Hi-res image Download (PPT) In summary, tailor's bunion is an inherited, progressive deformity that is frequently associated with certain foot types, aggravated by footwear, and painful when wearing normal shoes. Although nonsurgical measures may be used initially to reduce the symptomatology associated with this deformity, surgical repair is often necessary." @default.
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• W2047007827 title "Diagnosis and Treatment of Forefoot Disorders. Section 4. Tailor's Bunion" @default.
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