Linda came to my office with a
complaint of a hard painful bump on the outside of her right foot just behind the little
toe. She told me that it is red and painful whenever she wears closed shoes. With our rain
during the last few weeks she needed to wear closed shoes and boots. Consequently she was
in a good deal of pain and wanted to know what she could do to make her foot feel better.
I told her she was in luck. What she had was relatively easy to diagnose and treat. She
had a tailor’s bunion. Since Linda was a school teacher I moved into my teaching mode
and gave her a pop quiz. I asked her: if a Morton’s neuroma is named after Dr. Morton
and Sever’s disease is named after Dr. Sever, how did tailor’s bunion get its
name? She bit and tentatively answered: Dr. Taylor?. "Wrong", I said proudly,
using the same tone I heard so often when I was in school. It is a foot condition that,
like an aviator fracture or basketball heel, is named after an occupation or activity with
which it is associated. A hundred years ago, when the disorder got its name, it was the
fashion of tailors to sit on the ground crossed legged while they did their sewing.
Consequently the outside of the foot, and specifically the head of the 5th
metatarsal, rubbed on the ground with such vigor that it hurt. Linda pointed out that not
only is she not a tailor, she doesn’t even own a sewing machine. Like most disorders
named after an activity or occupation, most people who have the problem do not participate
in the activity. Maybe today it would more likely be named pump wearers bunion.
A tailor’s bunion also goes by the even cuter name of bunionette. It is analogous
to the more traditional bunion deformity found on the inside of the foot just behind the
big toe. Both are caused by the prominence of an otherwise normal metatarsal bone that has
shifted away from the neighboring metatarsals. Initial treatment for both are quite
similar as well. Wider and softer shoes can help. Placing pads on or around the bumps can
also give relief. Dr. Scholl’s makes a gel-like bunion guard that can be placed over
a bunion or a bunionettes to provide temporary relief.
When all else fails, surgery is a great choice for a nagging and persistent
tailor’s bunion. The procure takes less than an hour and usually involves both
shaving the bump and moving the bone back where it belongs. It is successful more than 95%
of the time. I have tried just shaving the bone and not repositioning it with less
successful results. It is done with just local anesthesia, usually with a touch of
sedation. An hour after the procedure, patients are back at home with their foot elevated
and wrapped in ice. Walking can be done immediately as long as a protective shoe is worn
for a few weeks. The sutures come out in 10 days and regular shoes are worn as soon as a
week or two after that.
Linda, having tried a variety of shoe modifications and pads in the past, elected
surgery which was performed earlier this week. The procedure was very successful and she
reports virtually no pain. Although I gave her a prescription for some, she has not needed
any pain medication. This is not uncommon with tailor’s bunion corrections. It is
actually not as painful as a pop quiz. (And if you come to see me about a painful bump on
the outside of your foot, you already have the answer.)
ACORN December 1993
An
"Epidemic" of Tailor's Bunions
By: Michael Zapf, D.P.M.,
M.P.H., F.A.C.F.O
As I write this there are only three more days of 1993. I hope all of you
have experienced a happy holiday season and I wish each and every reader a
prosperous and wonderful 1994. Christmas was very special for my family with an
18 month old in the house. Christopher almost knows what is going on. He was
certainly intrigued by all of the colored lights and was bound and determined to
give each of them a taste test. He is getting quite adept at unwrapping gifts,
although the bows and boxes are as exciting to him as the presents. I understand
from many of you that this will be the last Christmas where he is unaware of
Santa and all that that entails.
As you might imagine all of your local doctors are spending the last days
of 1993 wondering what will become of the practice of medicine starting next
year. Certainly the words "managed care" will be on more and more
lips. Every month fewer and fewer patients are able to come to a private
specialist like myself without at least a referral from their family doctor.
This pattern will likely become more the norm than the exception in the future.
Until then you can count on your local specialist to provide the most attentive
care possible. There has never been a more important time to make patients and
referring doctors happy.
Speaking of referrals, I have had three patients referred to my office in
December with tailor's bunions. Usually I only see three people a year with
painful tailor's bunions. It looks like a little epidemic.
A tailor's bunions, also known by the quaint name "bunionette,"
is a painful swelling behind the 5th toe (the one known to Christopher as the
"the little piggy who said 'Whee, whee, whee', all the way home). It is
caused by a bone that has become prominent and rubs against the shoe. To counter
a common notion, it is not named after a Dr. Tailor
It got its name during the middle ages. Tailor's plied their trade
sitting on the ground or floor with their legs crossed. This put the outside
edge of the foot against the ground. Hours of sitting for days on end caused the
bony prominence to hurt, sometimes excruciatingly. Today we use low and high
heeled pumps to accomplish the same thing. The more the trauma of wearing shoes
(or sitting cross legged, for that matter) the more pain you get. Eventually it
will get bad enough for you to make an appointment (or to ask your doctor for a
referral). Then you might end up in my office.
When these little guys hurt there is not much to do conservatively except
relieve the pressure. This can sometimes be done by changing to bigger, wider or
more comfortable shoes. I sometimes jokingly tell my patients that they could
move to Hawaii and just wear sandals and thongs (shoe variety) for the rest of
their livea. However, if the pain persists wearing the shoes you need to wear
and doing the things you need to do, then surgery is the answer.
The surgery is done on an out-patient basis under local anesthesia. A
piece of the bone is shaved and the bone itself is often cut and moved over and
out of the way. It takes less than an hour to perform the procedure and if both
feet have a painful tailor's bunion, they can be done at the same time.
Surprisingly, there is little pain or disability from this procedure. You
do need to wear a post-operative type of shoe for about a month. During this
time you are free to be active and can even return to work if the shoe is
acceptable to the boss. The procedure is overwhelmingly successful and very
gratifying to perform.
Well, happy new year everybody! And if you see anybody sitting on the
ground with their legs crossed and sewing a pair of pants, give them my card.
Dr. Michael Zapf is a board
certified podiatrist in practice in Agoura Hills and Thousand Oaks. He is on the
active staff of Westlake and Los Robles Medical Centers. For more information
please call his office at (818) 707-3668
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