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