Tailor's bunion (bunionette): shoes, padding, what exercise can't change, and when surgery helps

What a tailor's bunion is

A tailor's bunion, or bunionette, is a bony lump at the joint at the base of the little toe, on the outside of the foot, sometimes with swollen soft tissue around it. The little toe often angles in towards the fourth toe, and the foot becomes wider and harder to fit. US orthopaedic surgeons (the American Academy of Orthopaedic Surgeons) describe it as very much like a bunion, in a different spot.

Tight shoes rub the lump, so the skin can go red, swollen and sore, thicken into hard skin or a corn, or blister. A bursa, a small fluid-filled sac that reduces friction, can form over the lump and become inflamed. Surgeons' reviews add that the lump can sit on the side, the top or the underside of the end of the fifth metatarsal, the long bone that leads to the little toe.

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Three shapes of boneEmerging evidence

The lump can come from a wider end of the fifth metatarsal, a bone that bows outwards, or, most often, a bone that angles away from the fourth metatarsal, with the little toe angled in. In 91 painful feet compared with feet without the problem, the angle between the fourth and fifth metatarsals and the little toe's angle were larger, while a bowed bone and a wider end were not common. In 112 painful feet, the whole front of the foot was more splayed. The shape matters mainly to a surgeon choosing an operation.

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Who gets itEmerging evidence

NHS Lanarkshire says tailor's bunions are not as common as bunions. The only population figure we found comes from one Turkish survey in which 2,662 adults rated their own feet from pictures: 13.8% reported a bunionette, more often women, and 61.2% of them had a family history. Tight shoes were linked with it in both sexes. Rating your own feet from pictures isn't a diagnosis, so treat that figure as a rough guide.

NHS podiatry puts inherited factors and the shape of the foot's bones first, with footwear a contributing factor. It also lists old toe injuries, very flexible joints, getting older, inflammatory arthritis such as rheumatoid or psoriatic arthritis, tight calf muscles, and neurological conditions such as stroke, cerebral palsy, multiple sclerosis and Charcot-Marie-Tooth disease. It often comes with a bunion on the big-toe side, and teenagers can have it too. The name comes from tailors, who sat cross-legged with the outer edge of the foot rubbing on the floor; that story doesn't explain why people get one today.

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What an X-ray does and doesn't meanEmerging evidence

The lump is easy to see and feel, so an X-ray is usually taken only when surgery is being considered, to judge its cause and size. A lump on an X-ray isn't the same as a painful one: a review notes that the prominence is found in many people but seldom causes symptoms, and in 91 painful feet the painless other foot looked much the same, apart from a smaller angle between the metatarsals. Among 81 feet having big-toe bunion surgery, people whose bunionette showed on the X-ray but caused no symptoms did as well without an operation on it. So the X-ray shows the shape; the shoe, the skin and an inflamed sac usually explain the pain.

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How it usually goesEmerging evidence

The bump doesn't go away. NHS podiatry says non-surgical care "will not correct or reduce the size or shape" of it, but that most people's pain decreases with it. One NHS board's leaflet expects symptoms to start improving within about 3 months, and its web page says flare-ups usually settle within 6 weeks.

Expert reviews say painful bunionettes usually respond to wider shoes and padding, but no study has tested non-surgical care, and a 2026 review found no long-term studies of it. In 100 people, the most severe type went with worse foot pain, foot function and footwear scores.

Sources 1, 2, 4, 13, 14

Shoes, padding and insoles: the standard first treatment, untestedEmerging evidence

NHS podiatry services advise shoes wide and deep enough for the bump, with softer uppers that mould around it rather than hard patent leather; padding such as fleecy web or semi-compressed felt over a sore or inflamed bump, or a plaster if the skin is broken; cushioned heels, good arch support and insoles; and resting and raising the foot in a flare. They advise against high heels, tight pointy shoes, flip-flops, backless slippers, walking barefoot on hard floors, and long spells walking or standing.

An NHS podiatric surgery service adds joint padding and protective shields, gel or silicone wedges between the toes, surgical footwear and insoles, and US orthopaedic surgeons suggest having shoes stretched where they press. Expert reviews say most painful bunionettes settle with wider shoes and padding. No trial has tested any of these measures, so the advice rests on clinical experience.

Sources 1, 2, 15, 16, 17, 3, 5, 4, 13

What exercise can and can't doEmerging evidence

No exercise has been shown to shrink or straighten a tailor's bunion, and an NHS leaflet on bunions that also covers tailor's bunions says there is no evidence that exercises can prevent further deformity. What exercise can do is keep the calf and the small muscles of the foot strong and supple, and keep you active while shoes and padding take the pressure off.

NHS Lanarkshire's leaflet gives the calf stretches and small foot-muscle exercises used in this plan, with doses. Its text says the exercises can help heel pain, which shows they are general foot exercises shared with the board's other leaflets, not a treatment for the bump, and they haven't been tested in a trial. A Bradford NHS service says to contact your GP or musculoskeletal (MSK) podiatry if the exercises cause a large increase in pain, or nothing has changed after 6 to 12 weeks.

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Toe spacers, splints, correctors and injectionsMixed evidence

No study has tested toe spacers, splints or correctors for a tailor's bunion, and nothing shows they change its shape. One NHS service lists gel or silicone wedges between the toes as a comfort measure, and for big-toe bunions, an NHS leaflet says night splints have poor evidence. Use them for comfort if they help; they won't straighten the little toe or shrink the bump.

US foot and ankle surgeons (the American College of Foot and Ankle Surgeons) list steroid injections for inflamed tissue around the joint. We found no trial of them for tailor's bunions, and an injection doesn't change the bump.

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When a podiatrist or a foot surgeon is the next stepStrong evidence

A podiatrist is the usual next step if a few weeks of the right shoes and padding haven't helped: they can advise on padding, insoles and footwear, and in many areas you can refer yourself. US orthopaedic surgeons say surgery may be recommended if, after a period of time, you still have pain and trouble walking despite changing footwear and other non-surgical treatments. An NHS podiatric surgery service says foot surgery should be avoided if it's only for looks.

So a foot surgeon (orthopaedic or podiatric) is for pain that carries on despite good non-surgical care, or skin over the bump that keeps breaking down. No trial has compared surgery with shoes and padding.

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Surgery: what the case series showEmerging evidence

The usual operation cuts and moves the fifth metatarsal (an osteotomy) so the bump sits in. Across 28 studies, every type reduced the angles, the average success rate was 93%, and cuts near the toe had the fewest major complications; 92% to 100% of people were satisfied. In open surgery, complications were reported after 22% of cuts near the base of the bone, 21% along its shaft and 11% near the toe.

Keyhole (minimally invasive) versions did well in 18 studies of 714 feet, with complications in 0% to 21.4% and the bone failing to heal in 0% to 5.6%, but none compared them with open surgery. In 49 feet treated this way without screws, pain fell from 8 to 0.3 out of 10. They may suit severe bunionettes less well: in 31 feet, results were poorer for severe ones, and 9 people wouldn't have the operation again.

Shaving off the bump alone suits few people, because it can come back or too much can be removed: in 21 feet followed for about 6 years, 15 had good, 3 fair and 3 poor results. Removing the end of the bone isn't recommended as a first operation: 64% of 11 feet had complications over 9 years. In 13 teenagers' feet, a sliding osteotomy gave excellent or good results in all. All of this comes from case series, not trials.

Sources 20, 13, 21, 22, 23, 5, 24, 25, 10

Recovery after surgery: one NHS service's timelineEmerging evidence

In one NHS podiatric surgery service, the operation is a day case under local anaesthetic. You rest with the foot raised and walk only to the bathroom for the first 2 to 3 days; the stitches come out at 2 weeks, then you wear a roomy trainer and start exercises to regain strength and movement in the toe joint. Sixty per cent of its patients are back in roomy shoes at 6 weeks and 90% at 8; work and driving (once you can make an emergency stop) follow from about 6 weeks, and sport and the gym at 12 weeks. Slight swelling can last 6 months, and healing is complete at a year. Your team's plan comes first.

The risks it quotes: infection 2 in 100, slow skin healing 8 in 100, the bone not healing 15 in 1,000, a fracture from not following advice 2 in 100, prolonged swelling and a thick or sensitive scar 4 in 100 each, a loose screw or wire 2 in 100, a stiff toe 1 in 100, a toe that doesn't touch the ground, pain moving to the neighbouring joints, and blood clots.

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Diabetes and a sore over the bumpStrong evidence

With diabetes, a wound, blister, ulcer or infection over the bump needs your diabetes foot team: NICE (the National Institute for Health and Care Excellence) asks for these to reach a specialist foot service within 1 working day. In 10 feet with stubborn ulcers over the end of the fifth metatarsal, a keyhole operation to reshape the bone healed the ulcers in an average of 9.8 weeks, but that is a decision for the diabetes foot team.

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Shoes, padding and hard skin (written steps)

From NHS podiatry advice in Lanarkshire and Bradford, an NHS podiatric surgery service, US orthopaedic surgeons and the NHS corns page.

• 1. Choose shoes wide and deep enough for the bump, with soft uppers that mould around it, a fastening, a cushioned heel and arch support.
• 2. Leave out high heels, tight pointy shoes, flip-flops and backless slippers, and don't walk barefoot on hard floors.
• 3. Have shoes stretched where they press on the bump.
• 4. If the skin or the fluid-filled sac over the bump is sore, cover it with fleecy web or semi-compressed felt padding from a pharmacy, or a plaster if the skin is broken.
• 5. Gel or silicone wedges between the toes may make shoes more comfortable.
• 6. Hard skin or a corn over the bump: soak it in warm water, use a pumice stone or foot file, and moisturise; don't cut it. If you have diabetes, poor circulation or a weakened immune system, see a GP or foot specialist instead.

Sources 1, 2, 15, 17, 3, 28

NHS Lanarkshire's toe exercises (written steps)

From NHS Lanarkshire's tailor's bunion leaflet, which is past its review date. They have no 3D demo. Do them once a day in stage 2, and leave out any that make the bump sorer.

• 1. Toe lift and grip: sit with your heel and the ball of your foot on the floor. Lift your toes up towards you and hold for 5 seconds, then grip the floor with the tips of your toes, lifting your heel very slightly, and hold for 5 seconds. Move between the two 10 times; if your foot cramps, do fewer.
• 2. Band toe press: sit with your knee bent to about a right angle and the foot on a strip of exercise band. Pull the ends of the band up over your knee so it lifts your toes, and hold it against your thigh. Keeping your heel down, slowly push your toes down to the floor against the band, then let them rise slowly. Aim for 3 sets of about 10 to 15, and change the band's tension to make it easier or harder.
• 3. Ball arch roll: sit with your heel and the ball of your foot on the floor and your toes curled over a small ball. Slowly lift your heel and roll the ball under your toes, keeping your toes on it, and hold for 3 seconds. Roll back slowly, putting your heel down before the ball of your foot. The leaflet gives no number; 10 is a sensible start (editorial).

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Ice and painkillers

Use an ice pack or a bag of frozen peas wrapped in a towel for up to 20 minutes, a few times a day, never straight on the skin, and not if you have chilblains or Raynaud's. NHS advice differs on how long: up to 20 minutes every 2 to 3 hours on the NHS toe pain page and NHS Lanarkshire's web page, 20 minutes every hour when it's swollen in its leaflet, and up to 5 minutes at a time on the NHS bunions page.

The NHS toe pain page suggests painkillers such as paracetamol or ibuprofen gel, or ibuprofen tablets if needed. Follow the dose on the packet.

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After tailor's bunion surgery (as your team allows)

One NHS podiatric surgery service's typical timeline. Your team's plan comes first, and the weeks are typical, not deadlines.

• 1. Days 0 to 3: keep the foot raised to hip level, and walk only to the bathroom, on crutches if you were given them. Keep the rest of the leg moving: ankle circles, 10 slow circles each way, inside the dressing (the move page's dose), and thigh tightening and straight leg raises, 10 of each, a few times a day (editorial, as in our bunion surgery guide).
• 2. From about 2 weeks, once the stitches are out: a roomy trainer, and the toe exercises your team gives you. Add the seated calf stretch with the towel round the middle of the foot, not the toes, and towel toe curls once the wound has healed and your team agrees (editorial).
• 3. From about 6 weeks: roomy shoes (60% of the service's patients by 6 weeks, and 90% by 8); work, and driving once you can make an emergency stop; the stage 2 moves and an exercise bike.
• 4. From about 12 weeks: sport and the gym, which is stage 3. Slight swelling can last up to 6 months, and healing is complete at about a year.

Source 17