Abstract
Objective: To report the clinical and radiographic results of surgical treatment of bunionette deformity with a minimally invasive technique without the use of hardware. Methods: This is a case series of 13 patients (14 feet) with a diagnosis of bunionette surgically treated with a minimally invasive osteotomy of the fifth metatarsal. All patients completed the American Orthopedic Foot and Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain preoperatively and in the last follow-up visit. Radiographic measurements included the fourth-fifth intermetatarsal angle (4-5 IMA) and the fifth metatarsophalangeal (MTP-5) angle. Complications and level of patient satisfaction were also documented. Results: Mean follow-up was 12.3 months. The mean AOFAS score increased from 51.3 to 94.0, and the VAS score decrease from 7.5 to 1.1. The MTP-5 angle decreased from 11.5º to 2.3º, and the 4-5 IMA decreased from 9.8º to 3.6º. These outcomes showed a statistically significant difference (p<0.001). The only complication was hypertrophic callus formation observed in 3 feet (21.4%). There were no cases of infection, neurapraxia, wound dehiscence, nonunion, or deformity recurrence. Ten patients rated their outcome as excellent and 3 as good. Conclusion: Treatment of bunionette with percutaneous osteotomy of the fifth metatarsal without the use of hardware showed good clinical and radiographic results, with a low complication rate and a high level of patient satisfaction. Level of Evidence IV; Therapeutic Studies; Case Series.
Highlights
Tailor’s bunion or bunionette is a deformity of the fifth metatarsal head characterized by a bony prominence on the lateral, dorsolateral, or plantar aspect of this bone
Bunionette deformity typically presents with pain in the lateral and/or plantar region associated with callus formation and difficulty wearing closed toe shoes
A total of 13 patients (14 feet) with a diagnosis of bunionette were evaluated in this study
Summary
Tailor’s bunion or bunionette is a deformity of the fifth metatarsal head characterized by a bony prominence on the lateral, dorsolateral, or plantar aspect of this bone. Du Vries and Coughlin classified the anatomic variations of this deformity into 3 types. There is an increase in size of the lateral fifth metatarsal head condyle, in type 2 (10%) there is a lateral deviation at the metadiaphyseal junction, and in type 3 (57-74%) there is an increased intermetatarsal angle between the fourth and fifth metatarsals[2,3]. Bunionette deformity typically presents with pain in the lateral and/or plantar region associated with callus formation and difficulty wearing closed toe shoes. Clinical examination clearly shows an increased intermetatarsal angle with abduction of the fifth metatarsal and a varus fifth toe.
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