Wednesday, June 9, 2010

Tailor's Bunion


Tailor's bunion is as an acquired lesion that causes chronic pain and swelling over the outer aspect of the distal foot. It is also known as a bunionette and is characterized by a painful prominence on the outer aspect of the foot in the area of the fifth metatarsal head.

These types of lesions were often seen on tailors with a cross-legged sitting posture. The posture resulted in pressure being placed on the lateral side of the foot.

Causes

Extrinsic causes - Commonly chronic
  • Tailors' posture
  • Footwear

Intrinsic causes

Structural Abnormalities
  • Lateral bowing of the metatarsal shaft
  • Enlargement of the metatarsal head
  • Congenital splayfoot

Presentation
  • Symptoms - Painful keratoses on the outer, bottom, or top aspect of the metatarsal head.

Imaging Studies
  • Weight-bearing x rays of both feet
  • Vascular studies are important with patients who have questionable circulation

Treatment

Conservative
  • Padding
  • Shoe modification
  • Orthotic devices
  • Anti-inflammatory medications
  • Corticosteroid injections

Surgical Treatment

  • Can be treated with simple removal of osseous bump when there is no evidence of anglular deformity
  • With an angular deformity or a deviation in the bone is present an osteotomy (cut in the bone) is made and held together with a screw. The level of bone cut varies with the level of the deformity.

Possible Complications

  • Malunion- Incomplete union or union in a faulty position
  • Nonunion- A nonunion occurs when a broken bone does not heal
  • Nerve Injury
  • Joint pain and stiffness
  • Symptomatic hardware
  • Infection
  • Recurrence

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