A tailor’s bunion or bunionette is a bony lump at the side of your fifth toe joint.
The fifth toe rotates in towards the fourth toe, changing the angle of the fifth toe joint. This change in joint angle creates a more prominent bony area at the outer aspect of the foot which can get red, swollen and painful.
Tailor’s bunions are less common than bunions at the big toe. It is between three and 10 times more common in women than men.
Causes
Tailor’s bunions can occur from multiple factors:
- Weight – If you have a higher than average BMI you are more at risk.
- Strength – Poor strength within the core foot muscles and lower limb.
- Footwear – Soft, flexible soled footwear provide little support in the forefoot which can increase the stresses going through the small joints of the foot. Narrow toe boxes and pointed toe boxes can force the toes together and compress the toes. Wearing footwear with a high heel also increases the stress on these tissues.
- Altered foot function – The presence of existing foot deformities such as hallux valgus (bunions), flat feet or high arched feet can all lead to overloading within these joints.
- Other medical conditions – Osteoarthritis and many inflammatory joint diseases (for example rheumatoid or psoriatic arthritis) affect the small joints in the foot making them more vulnerable to this condition.
- Occupation – Certain occupations may lead to greater strain on these joints.
Symptoms
The most common symptoms of a tailor’s bunion include:
- Pain at the side of the foot or base of fifth toe.
- Pain, swelling and redness around the toe joint due to joint inflammation.
- Reduced strength within the affected toe.
- Difficulty walking/weight bearing.
- Painful callous and corns overlying the joints of the toe.
- Deformity: visual changes in the joint structure.
- Restricted range of movement: limited movement up or down within the small toe joints.
How long will it take to get better?
Tailor’s bunions cannot get better, but there are things that you can do to improve your symptoms if it is painful. Self-help or self-management is very important to relieve pain and improve function.
Treatment options
Treatment is aimed at reducing the stress and load through the affected joint. This helps to:
- reduce pain
- improve strength around the affected joint
Changes in lifestyle can also be helpful to reduce your pain. The one person who can help you manage your symptoms is you.
Footwear
One of the most important changes you can make is to your footwear.
- Avoid walking in bare feet until your pain has resolved
- Avoid high heeled shoes, narrow toe boxes, or shoes with a flexible sole as these place increased stress on the joints of the forefoot.
- Avoid shoes which cause you to claw your toes such as flip flops / mules / crocs.
- Avoid wearing your old shoes that have heavy wear of the sole which could be causing you to increase load through the worn areas.
- Avoid shoes that are too narrow for your feet and aggravate the affected area
Look for a shoe that has the following qualities:
- Heels should be broad and no more than 1.5 inches high.
- Soles should be firm and non-pliable.
- Wide fitting footwear will provide plenty of room for your toes and accommodate any potential toe deformity.
- Lacing or velcro straps to hold the shoe firmly to the foot – for example, running or walking shoes.
- A rocker at the forefoot can limit bending of the joint during gait and therefore reduce pain- see picture below.
See our footwear video and footwear advice printout for more information.
Strengthening and stretching exercises
Targeted strengthening and stretching exercises for the muscles in and around your foot and ankle can help to improve your symptoms. Local NHS Ayrshire & Arran podiatrists have devised exercise videos to help with strengthening the correct muscles.
See our list of exercises below.
Ice
Icing can be beneficial in the first 2-3 days following injury or to help manage any flare ups of pain. Please click here for more advice on how to ice your foot. Some people do find continual benefit of regularly icing for several weeks following the injury.
Weight management
If you have a higher than average body mass index (BMI) you are more at risk. Please click here for further support with managing weight.
Foot orthoses
Foot orthoses: may be considered if self-management and exercises have not improved your symptoms. Your local MSK podiatrist may prescribe some foot orthoses to wear in your shoes to try and offload the joint. Relief can be felt from an orthotic that helps with your gait (walking) pattern.
Investigations and surgery
Do I need a scan?
Tailor’s bunions are usually diagnosed primarily via a physical examination and patient history. X-rays and additional imaging tests such as diagnostic ultrasound scans can help evaluate the extent of deformity and identify any synovitis (inflammation within the joint).
Will I need surgery?
Surgical management is not usually considered unless you have tried all of the above measures and continue to have difficulty walking or with pain. If all non-surgical treatment has failed then it may be appropriate for a referral to an orthopaedic surgeon to consider a surgical intervention.
Exercises
The exercises below have been provided to help with your ankle osteoarthritis. If there is any doubt about your fitness to do these exercises then please discuss this with your GP.
You may find that these exercises may slightly increase your symptoms initially. However you should find the exercises themselves will become easier to do and that you begin to move your foot and ankle more easily. The exercises can take up to 12 weeks for you to notice a great improvement.
If these exercises cause a large increase in your pain or after 12 weeks there are no noticeable changes in your day to day symptoms then please contact your GP or NHS inform for more advice.
Pain during exercise
Within the scale, aim to stay in the green or amber boxes. If you are in the red area then you can modify the exercises by:
- reducing the amount of movement during an exercise
- reducing the number of repetitions
- reducing the weights
- reducing your speed
- increasing rest time between sets
Pain after exercise
Your pain or other symptoms should return to your pre-exercise baseline within 30 minutes of exercising. On the morning after your exercises, you should not feel an increase in pain or stiffness that lasts longer than 60 minutes.
Disclaimer
Please note: These exercises should not be used without prior consultation with a medical professional as the use of the wrong exercise may cause additional health related issues and discomfort. NHS Ayrshire & Arran and MSK NHS Ayrshire & Arran are not liable or responsible for any harm, losses or damages whatsoever resulting from the use or misuse of the information contained in or implied by the provided information in each video. These are provided for information only.
If you have any concerns about your ability to perform exercise then please discuss your concerns with your doctor or healthcare provider prior to participating in any advice that is on the MSK NHS Ayrshire & Arran website.
It is recommended to use your ice pack (cryocuff) or cool pack after your exercises to reduce the pain and discomfort this may cause.
Please choose the most relevant exercise section for you.
1. Seated Toe Grip Strengthening Using a Ball Exercise
This is performed in seated position.
Using a small spiky ball. Try to grip the ball with your toes and keep repeating this action. If you get a good grip on the ball try to pick it up.
Aim to build to 3 sets of 15 reps daily.
2. Seated Toe Grip Strengthening With Towel Exercise
This is performed in seated position.
Use your toes to begin crunching the towel up with the aim of pulling the towel in towards you, do this in a slow controlled manner whilst maintaining your heel on the ground. When you have pulled the towel in as far as possible straighten it back out again.
Aim to build to 3 sets of 15 reps daily.
3. Resistance Band Strengthening Exercise For Toe Flexor Muscles
This is performed in seated position.
With your leg bent comfortably at 90 degrees with your foot placed flat on a strip of resistance band. Pull the end of the band over your knee towards you which in turn will pull your toes up into a flexed position. Anchor the band on your thigh maintaining a good level of tension on the band throughout the exercise. Hold the band tight and begin to slowly push your toes down towards the ground against the resistance of the band, when your toes reach the ground allow them to slowly raise back up to their starting position.
Aim to build to 3 sets of 15 reps daily.
4. Seated Short Foot Exercises
Start in a seated position with your foot flat on the ground. Straighten your toes and press them gently into the ground whilst sliding the ball of your foot back towards your heel and lifting the arch of your foot. Be careful not to claw your toes whilst doing this exercise or lift the ball of the foot off the ground. Hold for 5 seconds.
Aim to build to 3 sets of 15 reps daily.
5. Standing Short Foot Exercise (progression)
Start in a standing position and straighten toes and press them gently into the ground whilst sliding the ball of your foot back towards your heel and lifting the arch of your foot. Be careful not to claw your toes whilst doing this exercise or lift the ball of the foot off the ground. Stand close to a wall or hand rail to aid with balance if required. Hold for 5 seconds.
Aim to build to 3 sets of 15 reps
6. Toe Spreading
In a seated position, with feet flat on the floor, try to lift your toes slightly and separate your toes (spread them apart). Do not allow the ball of your foot to come off the floor. Hold the position for 3 seconds.
As this becomes easier, you can try doing this exercise standing.
Aim to build to 3 sets of 15 reps.
7. Seated Towel Calf Stretch – Knee Straight
Place a towel around the ball of the affected foot and avoid bending your knee. Pull the towel toward you until you feel the stretch in the bottom of your foot and back of your calf muscle.
Hold the stretch for 30 seconds and repeat 3 times.
8. Seated Towel Calf Stretch – Knee Bent
Place a towel around the ball of the affected foot and bend your knee. Pull the towel toward you until you feel the stretch in the bottom of your foot and back of your calf muscle.
Hold the stretch for 30 seconds and repeat 3 times.
9. Standing Calf Stretch – Knee Straight
Place your hands on a wall for support and take a step back with the affected foot. Now begin to bend the knee of your front leg whilst moving your chest towards the wall until you feel a stretch in the back of you calf muscle.
Hold for 30 seconds and repeat 3 times.
10. Standing Calf Stretch – Knee Flexed
Adopt the same starting position as you did for the previous exercise. Slide the affected foot towards the front foot as demonstrated. This time when bending the front knee, also bend the knee of the back leg until you feel a stretch deeper in the calf muscle.
Hold this for 30 seconds and repeat 3 times.
11. Sole of Foot Wall Stretch
This exercise is aimed at stretching the sole of the foot. In a seated position cross your affected foot over your knee. Clasp your toes of the affected foot and pull both your ankle and toes up until you feel a stretch in the sole of your foot. Hold this position for 30 sec and relax. Repeat 3 times
Do this exercise once a day.
