Degree of Impact of Tailor's Bunion on Quality of Life: A Case-Control Study.

Tailor's bunion (TB) disease should be considered one of the foot injuries that causes disability in feet as well as general health. This case-control descriptive study investigated and contrasted the effects of different TB types in a sociodemographic population using the Foot Health Status Questionnaire (FHSQ). A sample of 100 subjects with a mean age of 51.70 ± 17.78 years was recruited and requested to reply to a foot health survey. Results were self-reported. Subjects were scored. Participants with TB type III (TB3) registered lower scores for foot pain, foot function, footwear, and foot health. Physical activity and social capacity had higher scores, and vigor and general health were lower. A Kruskal-Wallis test was used for systematic differences between the FHSQ and different TB types. In all analyses, statistical significance was considered a p-value <0.05 with a 95% confidence interval. Statistically significant differences were found between all domains of the FHSQ and TB, except for the social capacity domain and vigor. The FHSQ is an important measurement tool in TB subjects, showing that factors such as sex, age, and footwear used throughout an individual's life are significantly associated with the development of TB3 and its influence on foot pain and foot health.

Bunionette deformity corrected with "shortening" scarf osteotomy of the fifth metatarsal: mid-term results of a 34-cases.

BACKGROUND: The aim of this study was to evaluate the clinical and radiological outcomes (in mid-term) after "shortening" scarf osteotomy of the fifth metatarsal for the treatment of bunionette deformity. METHODS: We retrospectively reviewed the functional score - American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale, radiographic results - 4th/5th intermetatarsal angle, varus angle of the 5th metatarsophalangeal joint and complications in a consecutive series of 34 feet (27 patients) with bunionette. Nine males and 18 females (mean age: 45 years) were included in the study. Three males and four females were operated bilaterally The patients were operated on between 2004 and 2015, and evaluated during 2017. RESULTS: The average AOFAS score improved from 59.4 to 93 at a mean follow-up of 7.2 years. The 4th/5th intermetatarsal angle and varus angle of the 5th metatarsophalangeal joint decreased from 13.9°/19.5° preoperatively to 6°/5.9° at final follow-up. No neurovascular damage was recorded. Complications arose in five feet (14.7%): delayed union (n=1), early infection (n=1), distal screw migration (n=1), asymptomatic non-union (n=1), transverse metatarsalgia (n=1). The osteotomy healed within less than three months except twoo (delayed union, non-union). Three feet needed additional surgery: screw removal (n=2), Weil osteotomy of 2nd-4th metatarsals (n=1). CONCLUSIONS: "Shortening" scarf osteotomy is an acceptable, but not complication-free, treatment option for the bunionette deformity and offers promising results in the mid-term.

Direction and location of the nutrient artery to the fifth metatarsal at risk in osteotomy for bunionette.

BACKGROUND: The aims of this study were to identify the artery feeding the fifth metatarsal and determine how bunionette osteotomy could injure this vessel. METHODS: The nutrient artery entering the fifth metatarsal was investigated in 10 adult cadaveric lower limbs by barium injection and enhanced computed tomography. RESULTS: The nutrient artery entered the medial aspect of the fifth metatarsal around the junction of the middle and proximal thirds obliquely from a distal direction (mean angle 36°) in the coronal plane in all cases; in the axial plane, the point of entry and direction of the artery was medial-plantar (mean angle 49°). CONCLUSIONS: This report revealed direction and location of the nutrient artery entering the fifth metatarsal.

Management of Bunionette Deformity.

Bunionette deformity, historically known as tailor's bunion, is a forefoot protuberance laterally, dorsolaterally, or plantarlaterally along the fifth metatarsal head. Although bunionette deformity has been compared to hallux valgus deformity, it is likely due to a multifactorial, anatomic interplay between fifth metatarsal bony morphology and forefoot soft-tissue imbalance. Friction generated between the bony prominence, soft tissue, and associated constrictive footwear can result in keratosis, inflammation, pain, and ulceration. Symptomatic bunionettes are usually responsive to nonsurgical management. Surgical options are available based on the underlying bony deformity when nonsurgical treatment fails.

An Overlooked Deformity in Patients with Hallux Valgus Tailor's Bunion.

BACKGROUND: Tailor's bunion is a deformity of the fifth toe, and its concomitance with hallux valgus (HV) is defined as splayfoot deformity. Treatment is focused on the HV deformity in splayfoot, and the tailor's bunion deformity can be overlooked. The frequency of HV concomitant with tailor's bunion in splayfoot has not been reported in the literature. METHODS: A retrospective evaluation was performed to detect the existence of tailor's bunion deformity in 203 patients (376 feet) treated for HV. Standing anteroposterior and lateral radiographs were used in the radiologic evaluation. Fallat's classification was used to grade tailor's bunion. Surgery for HV was applied to 86 patients (136 feet), and conservative treatment was applied to 117 patients (240 feet). Mean follow-up was 28.3 months (range, 18-42 months). Clinical evaluation was by American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: Of the 376 feet with HV, 28 (7.4%) had tailor's bunion, of which 17 (60.7%) were overlooked according to the surgery criteria for tailor's bunion. In the HV surgery group, there were no differences in preoperative mean AOFAS scores according to concurrence with tailor's bunion, but postoperative AOFAS scores were low in patients with accompanying tailor's bunion (P < .001). In the conservative group, no differences were determined in mean AOFAS scores according to tailor's bunion. CONCLUSIONS: Tailor's bunion deformity sometimes goes undiagnosed in patients with treated HV. This deformity must be kept in mind for patients with HV to improve clinical results.

Percutaneous Surgery of the Forefoot.

This article describes some of the common techniques used in percutaneous surgery of the forefoot. Techniques such as minimally invasive chevron Akin osteotomy for correction of hallux valgus, first metatarsophalangeal joint cheilectomy, distal minimally invasive metatarsal osteotomies, bunionette correction, and hammertoe correction are described. This article is an introduction to this rapidly developing area of foot and ankle surgery. Less invasive techniques are continually being developed across the whole spectrum of surgical specialties. The surgical ethos of minimizing soft-tissue disruption in the process of achieving surgical objectives remains at the center of this evolution.

Fifth Metatarsal Osteotomies.

A tailor's bunion or bunionette deformity is a combination of osseous and soft tissue bursitis on the lateral aspect of the fifth metatarsal head. This article discusses 7 corrective measures: medial oblique sliding osteotomy with fixation, medial oblique slide osteotomy-minimal incision procedure without fixation, SERI (simple, effective, rapid, inexpensive) with fixation, chevron with or without fixation, closing, lateral wedge osteotomy at the metatarsal neck or proximal diaphysis, Weil osteotomy, and scarfette. These evidence-based techniques can be used by practitioners for medical management of their patients through evaluation, diagnosis, and prognosis. Complications are also addressed.

Diagnostic considerations of lateral column foot pain in athletes.

Foot maladies are often classified descriptively by general foot locations, i.e., forefoot, midfoot, and rearfoot. However, common vernacular verbiage, implicating a common biomechanical purpose, also applies pathology to the medial or lateral foot column. Although imprecisely defined, lateral column injuries to the foot encompass conditions that affect any of the lateral side of the foot from the calcaneus to the toes. The lateral column of the foot includes the calcaneus, the cuboid, the fourth and fifth metatarsals as well as the calcaneocuboid, cuboido-metatarsal, and intermetatarsal joints. It may be helpful to think in a "lateral column" fashion when evaluating and treating certain lateral foot injuries, load patterns, and biomechanical or anatomical faults. Misdiagnosed injuries in this area of the foot can be a source of great morbidity to the athlete. It is important for the clinician to be aware of common conditions presenting as pain to the lateral side of the foot.