Bunionette (Tailor’s Bunion)

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Expert Patient Guide · London

Bunionette (Tailor’s Bunion)

A clear, practical guide for patients by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon, Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL — London, UK.

At a Glance: Bunionette (Tailor’s Bunion)

Key factSummary
ConditionA painful bony bump on the outside of the foot at the base of the little toe, where the long bone leading to the little toe (the fifth metatarsal) ends.
Who It AffectsMore common in women (between two and ten times more likely than in men); often affects both feet.
Main CausesThe foot shape you inherit, a wide front of the foot, a curved little-toe bone and narrow or pointed shoes.
DiagnosisAn examination of your foot and X-rays taken while you stand; a standing 3D scan (weight-bearing CT) for more complex cases.
ClassificationThree types (Coughlin Types 1–3): an enlarged end of the bone, a curved bone, or a wider angle between the bones of the fourth and little toes.
Non-Surgical CareShoes with plenty of room at the front, padding, care for hard skin, insoles; occasionally an injection to settle an inflamed joint.
Surgical OptionsKeyhole (minimally invasive) realignment of the bone, or open realignment near the joint (distal osteotomy) or along the length of the bone (scarf-type shaft osteotomy).
RecoveryYou can walk in a special post-operative shoe from the day of surgery; most people are back in normal shoes and activities at around 8–10 weeks.
SpecialistMr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL, London. matthewwelck.com

01

What Is a Bunionette?

A bunionette — also called a tailor’s bunion — is a bony bump on the outer edge of the foot, at the base of the little toe. It forms where the fifth metatarsal (the long bone leading to the little toe) meets the toe itself. As the bump pushes outwards, the little toe often angles inwards towards the fourth toe.

The name dates back to tailors who sat cross-legged for hours, with the outer edge of the foot pressed against the floor. Today, the usual cause is pressure from closed shoes on a foot that is naturally wider at the front. It is the “mirror image” of a big-toe bunion (hallux valgus). Specialist assessment by a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck in London — can pinpoint exactly which part of the bone is causing the problem, which is the key to treatment that lasts.

02

How Common Is It?

Bunionettes are less common than big-toe bunions but are still a common reason for people to be referred to a foot clinic. They are reported to be between two and ten times more common in women than men, and both feet are often affected.

A bunionette rarely happens on its own. In one study of patients having surgery, around 60% also needed treatment for another problem at the front of the foot — most commonly a bunion (hallux valgus), big-toe arthritis (hallux rigidus) or hammer toes. This is why it is important to have your whole foot and ankle checked.

03

What Causes a Bunionette?

  • The foot shape you are born with (most common): the bone leading to the little toe angles outwards, making the front of the foot wide
  • A curved little-toe bone: the fifth metatarsal bows outwards along its length
  • A large end to the bone: the head of the fifth metatarsal is wider than usual
  • Splayfoot: a bunion and a bunionette together, widening the whole front of the foot
  • Footwear: narrow, pointed or high-heeled shoes that squeeze the outside of the front of the foot
  • The way your foot sits: flat feet (pes planus), a heel that tilts outwards, or a high arch (cavus foot) that puts extra weight on the outer edge of the foot
  • Inflammatory arthritis: rheumatoid arthritis and gout can make the little-toe joint swell and look like a bunionette

04

What Are the Symptoms?

  • A visible bump on the outside of the foot at the base of the little toe
  • Pain, rubbing and redness over the bump, worse in closed or narrow shoes
  • Hard skin (callus or corn) on the side or underside of the little-toe joint
  • A swollen, inflamed fluid sac (bursitis) over the bump
  • The little toe drifting inwards or curling under the fourth toe
  • Difficulty finding comfortable shoes, especially for work or sport

If you have pain under the joint, it may mean the end of the bone is sitting too low. This affects which operation is planned, as the bone may need to be lifted as well as moved inwards.

05

Investigations & Classification

  • Examination — your whole foot and ankle will be checked, including the position of your heel, the height of your arch, your skin and your other toes
  • Standing X-rays — X-rays taken while you stand are the first test, and allow the important angles in your foot to be measured
  • Standing CT scan (weight-bearing CT) — a low-dose 3D scan taken while you stand, used when the problem is complex, has come back or is combined with other foot problems; this is a standard part of Mr Welck’s practice
  • Blood tests, an ultrasound or an MRI scan — if inflammatory arthritis, gout or bursitis might be involved

What the X-ray measurements mean

On your X-rays, your surgeon will measure how far the little toe is angled (normally around 10°; painful bunionettes average 16° or more), the angle between the bones leading to the fourth and little toes (called the 4–5 intermetatarsal angle, around 6.5° in normal feet and nearly 9° or more with a bunionette, depending on how it is measured), whether the little-toe bone curves outwards, and the width of the end of the bone (normally about 11–14 mm).

The Coughlin Classification

The most widely used system, described by Coughlin, sorts bunionettes into three types depending on where the problem lies. Each type usually suits a different operation:

TypeWhat is wrongTypical surgical approach
Type 1The end of the little-toe bone is enlarged or sticks outCutting and realigning the bone near the joint (distal osteotomy) — often done by keyhole surgery
Type 2The bones sit at a normal angle, but the little-toe bone curves outwardsCutting along the length of the bone (shaft osteotomy) or keyhole surgery to straighten it
Type 3A wider angle between the bones of the fourth and little toes — the most common typeCutting the bone (osteotomy) and swinging it back towards the fourth toe

Some feet have features of more than one type. When a bunionette comes back after surgery, it is most often because the underlying cause was not corrected, which is why getting the type right comes first.

06

Non-Surgical Treatment Options

Most patients start here, and many never need an operation:

  • Shoes with a wide, deep front (toe box) and soft uppers, and avoiding narrow or pointed styles
  • Having favourite shoes professionally stretched over the bump
  • Silicone or gel bunionette pads and toe spacers to reduce rubbing
  • Regular visits to a podiatrist to gently remove painful hard skin (callus)
  • Insoles to support your foot if too much weight is going through its outer edge
  • Anti-inflammatory painkillers when symptoms flare up
  • In some cases, a steroid injection, guided by ultrasound, to settle an inflamed joint or fluid sac (bursa)

These measures cannot change the shape of the bone, but they often control symptoms well enough that surgery is not needed.

07

Surgical Options, Including Minimally Invasive Correction

Surgery may be considered if pain continues despite changes to your footwear. The right operation depends on your Coughlin type, how large the bunionette is, the condition of your skin and any other foot problems, and is tailored to you. Simply shaving off the bump is now rarely recommended on its own, because the bunionette usually comes back.

Minimally Invasive (Percutaneous) Osteotomy

The bone is cut through tiny incisions (2–3 mm) using a fine burr (a small drill-like tool), guided by live X-ray images. The end of the bone is then moved inwards to narrow the foot. With most techniques, no screws or wires are left in the foot; instead, the bone is held in place by a firm dressing. It is usually done as a day case (you go home the same day) using a nerve block, an injection of local anaesthetic that numbs the foot, and you can walk straight away.

An international group of expert keyhole foot surgeons agreed on using a single, complete cut through the bone, with the older step of shaving the bump needed only occasionally. Published studies report results similar to open surgery, with fewer wound problems. It suits Type 1 and many Type 2 and 3 bunionettes; for the most severe cases, open surgery may give a more reliable result.

Distal (Chevron or Subcapital Oblique) Osteotomy

The bone is cut near the joint through a small or standard incision, and the end of the bone is moved inwards and, if needed, upwards to relieve pressure underneath. It is usually held with a small screw or pin. This works well for Type 1 bunionettes.

Shaft Osteotomy (Scarf, Oblique or Reverse Ludloff)

For larger Type 2 and 3 bunionettes, the bone is cut along its length and turned to straighten it and narrow the angle between the fourth and little-toe bones. The bone is held with small screws. Published studies report good or excellent results in over 90% of patients.

Metatarsal Head Resection

Removing the end of the bone is kept for particular situations, such as severe rheumatoid arthritis or infection, because in other patients it can cause pain under the neighbouring bones of the foot.

Recovery and Risks

Most people walk in a stiff-soled post-operative shoe for 4–6 weeks, and should keep the foot raised as much as possible for the first 1–2 weeks. Most people are back in normal shoes and everyday activities at 8–10 weeks. Complications are uncommon but can include slow bone healing (the most common after keyhole surgery), infection, numbness if a small skin nerve on the outside of the foot is irritated, stiffness, pain under the neighbouring bone and the bunionette coming back. Mr Welck will talk these through with you in full so that you can decide on treatment together.

08

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — one of the UK’s leading specialist orthopaedic hospitals — and Honorary Associate Clinical Professor at UCL.

He specialises solely in problems of the foot and ankle. Alongside forefoot surgery, including bunion and bunionette correction, his interests include total ankle replacement, complex foot and ankle reconstruction, revision surgery, Weight-Bearing CT and sports injuries — including Achilles tendon tears and ruptures. He has authored over 50 peer-reviewed publications and completed two international fellowships (advanced specialist training).

Patients are seen across London and North London, with quick access to standing scans and a wider team of specialists. Every option is discussed openly, and together you agree a plan tailored to you. Visit matthewwelck.com to learn more.

09

Frequently Asked Questions

What is the difference between a bunion and a bunionette?

A bunion (hallux valgus) forms at the base of the big toe on the inner side of the foot. A bunionette, or tailor’s bunion, forms at the base of the little toe on the outer side. They share similar causes and can occur together, in which case both may be treated at the same time.

Can a bunionette go away on its own?

The bony bump does not disappear, but symptoms often settle with wider footwear, padding and callus care. Surgery is only considered if pain continues to limit daily life despite these measures.

Is bunionette surgery done as keyhole surgery?

Often, yes. Minimally invasive (percutaneous) correction uses incisions of a few millimetres and a small burr under X-ray guidance, usually as a day case. Open surgery is still preferred for some larger or more complex deformities.

How long is recovery after bunionette surgery?

Most patients walk in a stiff-soled post-operative shoe straight away, wear it for around 4 to 6 weeks, and return to normal shoes and everyday activities at 8 to 10 weeks. Swelling can take several months to settle fully.

When can I drive after bunionette surgery?

Surgery on the left foot in an automatic car often allows driving within about 2 weeks. For the right foot, most patients wait around 6 weeks, until they can walk comfortably and perform an emergency stop safely.

Will I be able to play sport again?

Yes. Low-impact exercise such as cycling and swimming usually resumes at 6 to 8 weeks, with running and field sports typically from around 3 months once the bone has healed.

Can both feet be operated on at the same time?

With minimally invasive techniques, operating on both feet at once is often possible if you would prefer a single recovery period. This is discussed individually, as walking is more restricted in the early weeks.

Where can I see Mr Matthew Welck for a bunionette in London?

Mr Welck consults across London and North London. NHS patients are seen at the Royal National Orthopaedic Hospital (RNOH) Stanmore. Private appointments can be booked on 07547 395 270 or by emailing secretary@matthewwelck.com.

10

Book a Consultation

If a painful bump on the outside of your foot is making shoes uncomfortable, specialist assessment can help you understand the cause and every available option — from simple footwear advice to minimally invasive correction.

Book a private or NHS consultation with Mr Matthew Welck, Consultant Foot & Ankle Surgeon in London and North London.

Related Conditions & Treatments

Key References

  1. Cooper MT, Granadillo VA, Coughlin MJ. The bunionette deformity — evaluation and management. Ann Joint 2020;5:7.
  2. Michels F, Demeulenaere B, Cordier G. Consensus in percutaneous bunionette correction. Orthop Traumatol Surg Res 2020. doi:10.1016/j.otsr.2020.03.029.
  3. Coughlin MJ. Treatment of bunionette deformity with longitudinal diaphyseal osteotomy with distal soft tissue repair. Foot Ankle 1991;11:195–203.
  4. Laffenêtre O, et al. Percutaneous bunionette correction: results of a 49-case retrospective study at a mean 34 months’ follow-up. Orthop Traumatol Surg Res 2015;101:179–84.
  5. Teoh KH, Hariharan K. Minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) of the fifth metatarsal for bunionette correction. Foot Ankle Int 2018;39:450–7.
  6. Martijn HA, et al. Fifth metatarsal osteotomies for treatment of bunionette deformity: a meta-analysis. J Foot Ankle Surg 2018;57:140–8.

This guide is for general information and does not replace an individual consultation.

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 22 September 2026

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