In a small percentage of patients, operative treatment will be beneficial. Surgery will not be recommended if you have poor circulation, uncontrolled diabetes, if you are a chronic steroid user, or if you smoke cigarettes4. Surgery should only be considered after nonoperative management has failed (including but not limited to physical therapy, medications, change in shoe wear, pads and other inserts, rest, and weight-bearing limitations as needed). The type of operative treatment is dependent upon the actual deformity. Operative options for treating bunionette deformities include:

A. If you have a painful prominence without a bony growth, the typical surgery involves removing the painful soft tissue of the little toe3.

B. If you have an enlarged bump at the outer end of the fifth metatarsal head (where the toe meets the foot), then sometimes, a podiatrist may recommend the removal of the prominent bone on the outer aspect of the fifth metatarsal head. In some individuals with a bunionette deformity, the outside aspect of the fifth metatarsal head is prominent and simply removing this will help the symptoms.

C. Cutting and repositioning the fifth metatarsal bone: In most patients with significant bunionette deformities, there is an increased angle between the fourth and fifth metatarsals (the long bones of the foot which connect to the toes) with the subsequently increased deformity at the fifth toe (metatarsophalangeal) joint. In these individuals, a formal cutting and repositioning of the bone (osteotomy) of the fifth metatarsal is necessary. This will allow the fifth metatarsal to straighten out. The bone may be held straight with a steel wire, screw, or plate and screws, depending upon the surgeon’s preference. Depending upon the exact nature of the deformity, the bone can be cut close to the bunionette or further up the foot to reposition the entire bone. These procedures are combined with a soft tissue tightening of the outer (lateral) joint capsule of the fifth metatarsophalangeal joint, further correcting the deformity1.

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