Minimally invasive bunionette correction

Abstract

Objective: Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with subluxation of the metatarsophalangeal joint. A minimally invasive osteotomy of the fifth metatarsal without internal fixation using burrs is an increasingly used alternative for symptomatic tailor's bunion deformity. Similar to open surgery procedures the type of osteotomy complies with the underlying pathology. Minimally invasive surgical (MIS) procedures allow comprehensive treatment of various types of tailor's bunion deformities.

Indications: Symptomatic tailor's bunion deformity, failed conservative treatment, a closed epiphyseal gap.

Contraindications: Osteoporotic bone, poor patient compliance.

Surgical technique: The technique comprises percutaneous resection of the lateral exostosis of the fifth metatarsal head with a straight burr and an osteotomy of the fifth metatarsal, either distally, diaphyseal or proximally with a conical burr due to the shape of the deformity, usually without internal fixation.

Postoperative management: Redressive wrapping, partial pain-adapted weight bearing. Non-steroidal anti-inflammatory drugs for 3-5 days, lymphatic drainage, intermittent cooling. Radiographic assessment on postoperative day 1; radiographic follow-up 6 weeks postoperatively. Thromboembolic prophylaxis.

Results: The clinical outcome is comparable to standard surgical procedures with the advantages of MIS. Based on our results and the current literature, the minimally invasive distal metatarsal osteotomy without fixation is becoming a reliable treatment for tailor's bunion.

Keywords: Metatarsal osteotomy; Metatarsophalangeal joint; Minimally invasive surgery; Percutaneous surgery; Tailor’s bunion.