Fifth Metatarsal Osteotomy for Bunionette

What is a bunionette?

A bunionette (a.k.a. tailor’s bunion) is a painful bony prominence, or bump, on the outside of the fifth (little) toe. Over


At left, presurgical X-ray of a 30-year-old woman with a bunionette, circled in red. At right, screws have been used to straighten the bunionette. This patient also had her bunion at the big toe fixed with screws.

time, the bunionette may become worse as the fifth toe moves inward and the fifth metatarsal (the bone connected to it) moves outward. Rubbing between the bump and tight shoes may also cause tough skin to grow over the fifth toe area. There are three types of bunionettes. All can cause pain and pressure on the outside of the foot.

What is a fifth metatarsal osteotomy?

An osteotomy is a bone cut. A fifth metatarsal osteotomy refers to a cut in the head, neck or shaft of the bone to make it straighter and the bony prominence smaller.

What is the goal of a fifth metatarsal osteotomy?

The goal of a fifth metatarsal osteotomy is to straighten the curve and reduce pain and rubbing on the outer side of the foot. This procedure is often done along with shaving the outer side of the bump.

When might surgery be needed?

Surgery is indicated if your bunionette (bump) is painful, does not improve with nonsurgical treatment and prevents you from wearing comfortable shoes. Nonsurgical treatment options include wearing wider shoes, shaving the callus on the outer side of the fifth metatarsal, padding the area or using a pre-made or custom orthotic device.

When should I avoid surgery?

Surgery should never be chosen before nonsurgical measures have been tried. Surgery should be avoided if you have an infection at the fifth toe or bunionette or if your toe has poor circulation. Poor circulation can be caused by smoking and diabetes and can lead to problems with wound healing after surgery. A fifth metatarsal osteotomy is not needed if the bone is well aligned.

General Details of Procedure

A fifth metatarsal osteotomy is an outpatient surgery; patients do not usually need to stay in the hospital overnight. The bump in the bone is cut down and the fifth metatarsal is cut and repositioned, which corrects its deformity and decreases pain.

Specific Techniques

An incision is made over the outside of the foot. The bone protrusion may be shaved. A cut may also be made in the shaft of the bone. The far end of the bone is then shifted inwards, and held in place with some hardware (see figures).

What happens after surgery?

The recovery will depend on the specific technique used. After surgery, the patient is not allowed to put weight on the operated foot for up to six weeks, which will require the use of crutches or a knee walker.
For the first two weeks after surgery, a splint with a bandage is worn, and the foot cannot get wet in the splint and/or bandage. For several weeks after surgery, the patient may have to elevate his or her foot above chest level to decrease swelling. Swelling may last for several months after surgery.
After a couple of weeks, the stitches are removed. In the following few weeks, the patient wears a boot to protect the foot. After another few weeks, the patient progresses to weightbearing and possibly physical therapy exercises. The boot may be removed several weeks after surgery.
Commonly, a bunionette is fixed as the same time as a bunion (a bump at the big toe). In that case, the recovery is determined by the procedure on the bunion.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Complications that may occur from a fifth metatarsal osteotomy include the bone taking a long time to heal or not healing at all. It is uncommon for the bunionette to come back.
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