Whilst a bunion deformity of the first ray may take precedence in size and physical disfigurement; it may be no more painful or inconvenient than a fifth ray bunion for the patient. The ratio of literature between bunions and bunionettes would suggest that a tailor's bunion is of little significance in comparison to a hallux valgus deformity. However, a bunionette may prove extremely significant to the patient who endures chronic pain or difficulty with shoe fitting.
Matthew Benson: Podiatry Encyclopedia

A bunionette is similar to a bunion, but on the outside of the foot. It is sometimes referred to as a tailor's bunion due to the fact that tailors once sat cross legged all day with the outside edge of their feet rubbing on the ground. This produced a pressure area and callus at the bottom of the fifth toe. Highly Reputable

JBJS VOLUME 83-A · NUMBER 7 · JULY 2001 BY MANJUNATH KOTI, MS(AIIMS), DNB(ORTH), FRCS(GLAS), AND NICOLA MAFFULLI, MD, MS, PHD, FRCS(ORTH) ➤The bunionette, or tailor’s bunion, is a painful osseous prominence on the lateral aspect of the head of the fifth metatarsal. This prominence occurs in many individuals but seldom causes symptoms.
➤Orthotic devices may be useful if a symptomatic bunionette results from excessive pronation of the subtalar joint.
➤Operative management to decrease the width of the foot and the osseous prominence is indicated when nonoperative treatment can no longer control symptoms and when the patient has special demands, particularly in sports. ➤A proximal osteotomy is able to correct most deformities. A distal osteotomy is recommended if medial translation of the head for one-third of the width of the metatarsal shaft produces a normal fourth-fifth intermetatarsal angle.

Authors Brown, Cullen & Ferris
Synonyms and related keywords: tailor's bunion, fifth metatarsalgia, opposite side bunion
A bunionette is a painful prominence on the lateral aspect of the fifth metatarsal head. While not as common as a medial bunion, it is a cause of chronic pain and shoe-fitting problems in individuals whose feet are characterized by a widened forefoot or in those who have a lateral splaying or prominence over the fifth metatarsal.

Pathological anatomy
The bunionette deformity is a prominence of the fifth metatarsal head, usually with medial deviation of the fifth toe. It is associated with
* wide fifth metatarsal head (Fallat and Bucholz 1980, Leach and Igou 1975) – Coughlin found this in 8/30 in his surgical series, but Nestor, in a large radiological series, did not find any significant difference in metatarsal head width between patients and controls
* lateral bowing of the 5 th metatarsal shaft (Fallat and Bucholz 1980) – however, Nestor et al (1990) did not find any increased lateral bowing in patients compared with controls; they considred this a normal variation which was made more symptomatic by increased 4 th-5 th MT angle
* an increased angle between the 4 th and 5 th metatarsal shafts - Fallat and Bucholz found a normal angle of 6.2deg, although some studies have used a value of 8deg as the upper limit of normal. Coughlin (1991) found an average angle of 10.6deg in surgically treated patients and Nestor (1990) an average of 10.8deg in 91 feet with bunionette compared with 9.1deg in 91 matched controls
* an increased incidence of hallux valgus – Nestor et al (1990) found a 23% prevalence of hallux valgus in patients with bunionette compared to 9% in controls, although there was probably some selection of controls implying that the difference with normal feet may be even higher

bunionette deformity may be created by wide 4-5 intermetatarsal angle;
- symptomatic plantar callus is 2nd to concomitant plantar flexion of the fifth metatarsal;
- soft corn caused by the pressure of the bone of the proximal phalanx of 5th toe (may be exacerbated by tight shoes);
- soft tissue surgery will not solve the problem and the offending agent is usually the condyle of the proximal phalanx of 5th toe;
- associated 5th toe cross over deformity:
- 5th toe lies contracted in a dorsal medial direction over the 4th toe;

Hohmann-Thomasen metatarsal osteotomy for tailor's bunion (bunionette)
JBJS A Vol 71, Issue 3 423-426, MS Steinke and KL Boll Department of Orthopaedic Surgery, Holstebro Hospital, Denmark.
We used subcapital displacement osteotomy of the fifth metatarsal bone and peg-and-hole fixation to treat a tailor's bunion (bunionette) in forty-four feet (twenty-seven patients). The result was good in 86 per cent, fair in 9 per cent, and poor in 5 per cent. All but one of the patients were satisfied with the result. The average medial displacement of the head of the fifth metatarsal was five millimeters. In all feet, secure union was noted in five weeks, and no patient had osteonecrosis of the head of the fifth metatarsal.

GUIDELINE TITLE Metatarsalgia/intractable plantar keratosis/Tailor's bunion. BIBLIOGRAPHIC SOURCE(S) * Academy of Ambulatory Foot and Ankle Surgery. Metatarsalgia/intractable plantar keratosis/Tailor's bunion. Philadelphia (PA): Academy of Ambulatory Foot and Ankle Surgery; 2003. 6 p. [26 references]
INTENDED USERS Podiatrists
GUIDELINE OBJECTIVE(S) To provide recommendations for the diagnosis and treatment of metatarsalgia, intractable plantar keratosis, and Tailor's bunion