What is a Tailor’s Bunionette?
A Tailor’s bunionette is a lump on the outer side of the foot. Just as a bunion sticks out on the inside of the big toe, a Tailor’s bunionette sticks out on the outer side of the little toe. The little toe often points inwards towards the fourth toe. The prominence rubs on shoes and can become inflamed or infected.
The term Tailor’s bunion is used as tailor’s traditionally sat on the ground with legs crossed as they worked. This puts the edge of the little toe on the ground. It was thought that this is how they developed. However, xrays show that the bone can have different shapes, and this can lead to the prominence, rather than it being something developed from a seating position.
If you have a Tailor’s bunionette, it is best to see an orthopaedic surgeon who specialises in the foot and ankle. You will need xrays to look for abnormalities in structure that may lead to the problem.
What does Surgery Involve?
This is a keyhole procedure. A small cut is made in the skin next to the lump. The bone is cut with a special instrument and this allows the toe to be realigned. Sometimes a screw is necessary to hold the position, but often, binding of the foot suffices.
Surgery is carried out under general anaesthetic, but can be carried out with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening.
Risks of Surgery
Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.
There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia – the process of being put to sleep for your operation.
Risks of Anaesthesia
The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.
You will have had injections to numb your foot so that you are not in pain after the operation. This injection will wear off after 18-24 hours, so you must take regular painkillers so that you are not in severe pain when the injection wears off. Ibuprofen and Diclofenac should not be used for more than a few days after the operation as they can interfere with bone healing.
The pain will settle over a few weeks. You may see blood stains on the dressings. This is normal and not a cause for alarm. If blood is dripping from the dressings however, return to hospital.
The foot will be swollen as well as sore. You should keep the foot elevated as much as possible for the first two weeks. Keep walking down to a minimum – going to the toilet or for meals. Letting the leg hang down will cause the foot to become more swollen. Most of the swelling will settle within the first few months, but swelling can continue for up to one year.
If you are resting on your sofa, keep your foot elevated on the back rest or arm rest. If you are resting in bed, then place a few pillows under the foot to keep it elevated.
You have been given a special shoe that does not allow you to put weight on the front of the foot. This is because the re-set bone is held together by screws, and putting weight on it can dislodge the screws holding the bone. You should wear this continuously for the first two weeks, including in bed. After that, you should wear it whenever you are walking, even at home. Crutches are for balance only.
After two weeks, you will be seen in the clinic and the stitches will be removed. Exercises are not required for the little toe, but you should try to keep the rest of the foot and ankle mobile.
RETURNING TO WORK
You will be wearing the special shoe for six weeks, and we will then take an xray. I advise that you do not return to work before this, especially if you are on your feet all day at work. Most people can drive after 8 weeks. Remember that not everyone is the same, and some people take a longer time to recover from their surgery. Please request a sick note before you leave hospital, if you need one.