Surgical treatment of a bunionette

Abstract

The term Bunionette or Tailor's Bunion is applied to an abnormal prominence on the lateral aspect of the fifth toe similar to the Hallux valgus of the first ray. Several different operative procedures-proximal, diaphyseal or distal-are advocated. Our analysis compares the clinical and radiological results of the distal oblique osteotomy and the distal Chevron metatarsal osteotomy. The clinical evaluation is based on the "Mayo Clinic Forefoot Scoring System" (max. 75 points). Radiographic examination includes measurement of the fourth to fifth intermetatarsal angel, the fifth metatarsal phalangeal angel, as well as the shortening of the fifth metatarsal ray. Overall clinical results were evaluated as very good in both surgical techniques, all the patients obtained more than 70 points in the score. The radiographic analyses show an improvement of the "functional angels" (IMT IV-V, MTP V) with both osteotomies. In all the cases of the distal oblique osteotomy there was a shortening of the fifth metatarsal bone and sometimes a tilting of the head with a consecutive "malalignment" of the metatarsal row without clinical impairment. The Chevron procedure resulted in correct positioning of the metatarsal head in all patients.