Tailor's bunion

by Arthur
(Massachusetts)

Hi

I have bunions on both feet, though they cause infrequent pain or trouble. However, on my left foot, I also have a tailor's bunion that flared up about four months ago and was diagnosed about two months ago. The angle is quite large and the doctor recommended an osteotomy.

There is pain on the side, at the leftmost point of the bunionette, but the greatest pain is actually on the bottom of the bunionette. It is almost impossible to walk on a hard floor barefoot. And even in padded, wide shoes, there is pain on the bottom of the foot, below the bunionette. I frequently tape a pad in the middle of the forefoot to narrow the foot a little and put less pressure on the area below the fifth metatarsal. All this has affected my gait and led to pain in other parts of the foot and ankle. By the way, I am naturally slew footed, though the skew on the left side is more pronounced.

I am an active hiker and distance runner, 56, average-to-light weight. Are there realistic options for repairing this short of the osteotomy, the main downside of which is six weeks of immobility and major loss of muscle? I've seen that in some cases resection may be an option, with far less downtime, and just noticed a tightrope procedure that is promising but doesn't have much history. What are the stats on recovery? What percentge of active people who undergo the osteotomy return to the same level of activity?

Many thanks for your advice,

Art

Hi Art,
If the lion's share of pain is on the bottom of the foot then any surgery anticipated has to have as its goal, elevation of the metatarsal bone and not necessarily decreasing the space between the fourth and fifth metatarsal heads.
Most cases of pain underneath are due to either a severely prominent fifth metatarsal head thus putting more pressure on the walking surface, or, a lack of plantar fat underneath the metatarsal head thus causing a lack of cushioning for the metatarsal, or, an inflamed bursitis underneath the metatarsal head.
The order in which I treat this would be: 1. accomodative padding in an effort to take pressure off the metatarsal head, or 2. if there is an inflamed bursitis, I would consider a cortisone injection, or 3: instead of an osteotomy, I might consider just a condylectomy which is a shaving away of the bottom of the metatarsal head in an effort to decrease the pressure exerted by the bone on the walking surface.
A condylectomy is a much simpler procedure than an osteotomy, with a quicker healing time, and no threat of non-union of the osteotomy, since an osteotomy is not being performed.
The tightrope procedure as I know it is reserved for bunion corrections and not tailor bunions.
Marc Mitnick DPM