Tailor's bunion
Prominence of the fifth metatarsal head can often be seen both in
conjunction with, or independent to, a standard hallux valgus deformity.
The prominence of bone may be due to an increased intermetatarsal angle or
as a result of a hypertrophied metatarsal head. It is known as a Tailor’s
bunion as it was initially thought to be prevalent in tailors who sat
cross-legged on hard surfaces whilst working, causing the outer edge of
the foot to become painful due to compression of the fifth metatarsal
against a hard surface.
Presentation
As with hallux valgus, the level of pain is not always related to the
extent of the deformity, for example, a bursa overlying the bony
prominence can intermittently erupt and this can be a source of great
pain. Few shoes are designed to accommodate a lateral forefoot prominence.
When there is excessive lateral forefoot loading due to rearfoot
pathology, the fifth metatarsal frequently deviates laterally and can
become overloaded and painful.
Treatment
Before correcting a prominent Tailor’s bunion, a careful diagnosis of the
cause is necessary. This is because all too frequently a simple
exostectomy is performed when a transpositional osteotomy is required.
Correction of any biomechanical deformity is important as Tailor’s bunions
are frequently encountered in younger people and the deformity may recur
if the pathomechanics are not addressed.
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