Does a Bunionette Need Surgery?

Bunionette surgery is an effective way to alleviate pain, discomfort, and deformities associated with the tailor’s bunion. A 2018 study by the National Library of Medicine revealed a mean success rate of 93% for bunionette surgeries.

But, how do you know when your bunionette requires surgery and what does the process involve?

When is Surgery Necessary?

Bunionettes are abnormal bony bumps or protrusions located at the base of the small toe (your pinky toe). Like the bunion, the bunionette or tailor’s bunion is usually harmless and will rarely require surgery. Instead, they are treated conservatively (non-surgically) through shoe modification, pain relief medications, padding, ice packing or orthotics.

However, when a tailor’s bunion becomes painful, severe or unresponsive to conservative treatment, your healthcare provider may recommend a bunionette surgery.

The type of surgical procedure recommended will depend on your activity level, the severity of the deformity, age and other underlying conditions.

Bunionette surgeries help to alleviate pain, eliminate deformity, and improve your quality of life. They usually have up to 93% success rate and are often beneficial when used.

What Does Bunionette Surgery Involve?

The bunionette surgery is not as complicated as it sounds - it is a day case/ outpatient procedure that often involves the removal of the bony prominence on your pinky toe.

But before this is done, your foot or ankle orthopaedic surgeon will examine your foot and request certain investigations such as an X-ray of the affected foot, a CT scan (rarely), and basic tests. Then, you will be counselled on the type of bunionette surgery that you need and why, the choice of anaesthesia, and what to expect after the surgery.

During the Surgery:

• Anaesthesia will be administered - this could be general, spinal, local anaesthesia, or a combination of some.
• Then the affected food is cut and the bony prominence is shaved or removed.
• In very large bunionettes, an osteotomy may be done. This involves cutting part of the fifth toe and re-aligning it.
• Screws, k-wires, or screws and plates may be applied to ensure the stability of the repositioned bones.
• Lastly, the skin layers will be covered using sutures, and the wound will be dressed.

This process is painless due to the anaesthesia and often lasts about 30 minutes to 1 hour. However, you will feel some pain after the surgery is completed and the anaesthesia wears off and this is likely to last about 24 to 72 hours.

Nevertheless, the intensity of the pain depends on the type of surgery and individual pain thresholds. Fortunately, you will be given pain medications to relieve the pain and aid quick recovery.

The Surgical Procedures

There are several types of surgical procedures used for the treatment of the bunionette deformity. However, as mentioned earlier, the type of surgery performed primarily depends on the severity of the tailor’s bunion.

The bunionette deformity is divided into three types.

• Type I – Bony prominence of the base of the fifth toe.
• Type II – Bony prominence of the fifth toe + bowing of the toe
• Type III – Increased angle between the fourth and fifth toes.

Some of the common types of surgical procedures include

• Distal Metatarsal Osteotomy
• Distal Chevron Osteotomy
• Lateral Condylectomy
• Metatarsal Head Resection
• Oblique Diaphyseal Rotational Osteotomy

Risks and Complications

Like every surgery or medical procedure, bunionette surgery has potential risks and complications. While these risks and complications aren’t common, it is essential that you’re well-informed about them before going ahead with your surgery.

Some complications you may have after your surgery include:

• Bleeding from the wound
• Infection
• Wound breakdown
• Recurrence
• Nerve damage (injury or entrapment)
• Deep vein thrombosis
• Under or over-correction
• Delayed healing of the bones
• Claw toe
• Recurrent pain
• Weakened or stiffened toe
• Loss of the affected toe

The type of complication or risk encountered depends on the type of surgery, underlying medication condition, and several other factors. Your foot surgeon will discuss these in detail with you while preparing you for the surgery.

How Long is the Recovery?

The average recovery time is about 6 to 12 weeks. However, the length of recovery can be influenced by the type of surgery, your age, nutrition and pre-existing health conditions.

Typically, after your surgery, the wound will be dressed, and a splint may be applied if necessary. Then, you’ll be asked to see a physiotherapist for advice on mobility using your post-surgical shoe or boot. You may also be taught to use a walker or crutches if necessary.

During the first few weeks, you’ll have to follow some steps to improve recovery. These include:

• Elevating your leg to reduce swelling and pain. Note that swelling usually takes over 6 to 12 months to completely subside.
• Minimising weight bearing on the involved foot or bearing weight as instructed.
• Keeping the bandage completely dry. This means covering the bandage with waterproof clothing when having your bath. Once the bandage and stitches have been removed, you can gently wash the area with warm water and soap and dab it with a dry cloth.
• Taking your pain medications as prescribed.
• Doing knee and ankle exercise at home to reduce rigidity and improve range of motion and flexibility.

The suture is often removed 10 to 14 days after the surgery and then 6 weeks after, a post-intervention X-ray is taken to assess healing. Also, once 6 weeks is completed, you may also be allowed to start bearing weight fully on the leg.

Availability and Costs (in the UK)

Generally, the cost of a bunionette surgery ranges between £4,500 to £6,000. The cost includes the consultation fee, pre-operative investigations, surgery, orthopaedic shoe, and post-operative care. This cost applied mainly to private hospitals.

On the other hand, bunionette surgery under the NHS is usually subsidised or completely free because of medical insurance. However, while the bunionette surgery is free or greatly subsidised under the NHS, the availability is low.

This is because you need to see a GP or podiatrist for detailed consultation and conservative treatment before referral to a foot and ankle orthopaedic surgeon. After a referral, you’ll need to join a waiting list for a consultation and the surgery as well. Conversely, private hospitals are faster as they have shorter wait times.