hi i'm dr hale today i'm going to talk about surgical options for taylor's bunions or
bunionette a bunionette is similar to a bunion but on the outside of your foot
a bunion is on the inside of the foot behind the big toe and a bunionette is on the outside of the
foot behind the fifth toe the bone behind the fifth toe is the fifth metatarsal and when the
head of the fifth spot of tarsal moves outwards it causes a prominence surgery is indicated
once you have exhausted all conservative options including wide tie type shoes shoe modifications
padding and orthotics in the majority of cases a bunionette is caused by the displacement of the
fifth metatarsal head in some cases people do form a bony outgrowth which we call a bone spur
to correct the bunionette we must move the bone back over a simple spur removal will not help
if the bone continues to be displaced next i'm going to describe the surgical procedure
the surgery requires a skin incision to allow access to the bone
a small amount of bone is removed from the outside of the fifth metatarsal head the fifth metatarsal
head is then cut and moved over to alleviate the deformity there are two different bone cuts to
allow the head of the metatarsal to be moved towards the inside of the foot one type of cut
goes top to bottom vertical and a wedge of bone is removed to move the head of the bone over
the other type a horizontal cut cuts from outside to inside and the bone is moved towards the inside
i've been doing this procedure for many years previously we did a lot more vertical wedge cuts
but the complication where it was higher and the patients had to be off their foot longer during
recovery overall any straight vertical cut is more unstable with a weight bearing for most cases an
hour i remove a small amount of bone from the side of the metatarsal head and then make a horizontal
cut which allows for more stable fixation and early weight bearing to allow faster healing
to bone a small screw is utilized to stabilize the bones the screw can be removed if necessary
but removal is not required we only remove the screw if the screw head causes discomfort after
the surgical procedure you typically have to be on questions for approximately two weeks we have to
take it easy for that time to allow the incision to heal even a small incision takes two weeks
to heal it takes about six to eight weeks for the bone to heal no matter what procedure is performed
you may be in a postdoctoral shoe or below knee boot for four to eight weeks after surgery in
addition if surgery is on the right foot you most likely will not be able to drive until you can
safely wear a shoe when selecting a procedure i take into account the deformity on x-ray activity
level age and other healing factors i suggest you select a surgeon who is board certified in foot
and ankle surgery i strongly suggest that patients do not have surgery in an office setting for this
condition but rather have surgery in a hospital or surgery center a hospital makes sure the
surgeon has the education experience to perform the procedure also i do not suggest a mentally
invasive surgery for this condition since it has a higher complication rate but slightly larger
incision your vital structures are clearly visible thus the complication rate is lower with an open
procedure the bone healing time is the same no matter what type of bone cut you have if you live
in western washington i strongly suggest vitamin d before and after surgery to help with bone healing
in summary for the treatment of bunionette a bony prominence on the outside of your foot i recommend
that you do conservative treatment first find a shoe that takes the pressure off the area if this
doesn't work you have to use padding or modify the shoe and orthotics if conservative therapy fails
you may need surgical invention to move the bone over so it does not rub on the shoe if you have
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