Bunionette Deformity

Associations

  • RA
  • Hallux Valgus & primus metatarsus varus – ‘splayfoot’
  • Women

Classification

  • Coughlin – based on description of reason for deformity:
    • Type 1 – Large 5th MT head
    • Type 2 – Bowed 5th MT shaft
    • Type 3 – Increased 4th-5th IM Angle >8 degrees

Symptoms

  • Often less symptomatic than Hallux Valgus
  • May just be aesthetic dissatisfaction
  • Painful callus – lateral or plantar

Examination

  • Screen for underlying inflammatory pathology
  • General foot examination – HV, hammer toes, etc.
  • Shoewear

Management

  • Non-operative where possible
  • Advice, shoewear modification, padding, callus management

Surgical

  • If non-operative fails
  • Traditional thinking is that:
    • Type 1 – Bunionette excision
    • Type 2 – Diaphyseal osteotomy
    • Type 3 – Basal osteotomy
  • No clear-cut consensus
  • Options are similar to HV – distal chevron or scarfette are mainstays
  • Beware proximal osteotomies and risk of non-union
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