OVERVIEW
A habit acquired since the Middle Ages and which concerns a particular profession gives the name to a deformity of the foot. The “tailor’s bunion” or “bunionette” in the English literature describes the swelling in the head of the fifth metatarsal; it was sometimes attributed to the hours the tailors spent sitting with their legs crossed, resulting in hardening in the area of ​​their small toe.

WHICH ARE THE SYMPTOMS?
The two main symptoms are chronic pain and irritation in the area of ​​the small toe, since the fifth metatarsal deviates outwards and the fifth toe deviates inwards. Moreover, the friction of the foot bump upon the shoe creates a callus (corn), which may be located on the lateral or plantar surface.
The so-called tailor’s bunion is not such a common deformity, as demonstrated by a study which was presented in 2006, at the annual conference of the American College of Rheumatology. According to the afore mentioned study, only 4% of the population which was examined for its needs had a bunion on the small toe, as opposed to 39% which had a bunion on the great toe (hallux valgus).

HIGH RISK GROUPS
High risk groups include women (a deformity may be present on both feet), but also those patients who have flat feet, or suffer from diabetes mellitus, or from angiological problems. However, the tailor’s bunion can occur in conjunction with other deformities of the forefoot, while it is a common complication after the surgery for the dropped metatarsal, in view of the fact that the leg load changes.
In addition, the wrong shoes and the hereditary anatomical peculiarities in the fifth metatarsal are considered “responsible”. The onset of the problem is gradual, and, usually, by the age of 40, the patients consult the doctor after they have experienced a hardening (callus-hyperkeratosis), they feel intense pain in the small toe area and find it difficult to find shoes. Frequently, a severe deformity of the affected area is observed.

WHICH IS THE BEST TREATMENT?
Initially, the orthopaedist shall recommend ways to reduce the pain. Silicone splint, wide, soft and comfortable shoes, even ice therapy or a medication can work as part of a conservative treatment. However, if the symptoms persist after a period of 6 months, or the deformity is such as to change the patient’s daily life, then surgery is an effective option.
In those without too severe deformities, a minimally invasive technique is considered the most modern one in orthopedic surgery, as a complete deformation correction is achieved, with minimal postoperative pain and an almost immediate mobilization. Osteotomies (artificial fractures and repositioning, in order for the shape of a bone to change) are performed with small tools and do not exceed 1 cm. The “corrections” of the fifth metatarsal bone are held by special biocompatible titanium screws for a permanent result, without a recurrence. During the operation, other foot deformities, mainly in the soft tissues, are corrected.
After surgery, the patient uses a special postoperative shoe, as neither a cast, nor crutches are needed. Suture removal is performed after approximately 10 days. The patient can promptly return to their daily activities.

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