Tailor’s Bunion (Bunionette): Causes, Treatment and Exercise
What Is a Tailor’s Bunion?
A tailor’s bunion, also known as a bunionette, is a bony prominence that develops along the outside of the foot at the base of the little toe. It involves changes around the fifth metatarsophalangeal (MTP) joint, where the fifth metatarsal meets the little toe.
As the condition develops, the outer portion of the fifth metatarsal becomes more prominent, and the little toe may angle inward toward the other toes. This can create pressure where the outside of the foot contacts footwear, sometimes resulting in pain, redness, swelling, or callus formation.
The name tailor’s bunion comes from the traditional cross-legged sitting position once associated with tailors. In this position, the outside of the foot could rest against the ground for prolonged periods, placing pressure over the fifth metatarsal. The name has remained, although we now understand that bunionettes can develop through a combination of foot structure, anatomy, biomechanics, and external pressure from footwear.
Some tailor’s bunions cause very few problems, while others become painful enough to interfere with footwear, walking, exercise, or other activities. Understanding the underlying structure and how the foot functions can help guide appropriate treatment.
Article Index:
Anatomy & Biomechanics
The foot is a remarkably complex structure composed of 26 bones, more than 30 joints, and an interconnected system of muscles, tendons, ligaments, and fascia. Together, these structures provide mobility, stability, shock absorption, and propulsion during walking and other activities.
Functionally, the foot can be divided into three regions:
Rearfoot: primarily the talus and calcaneus
Midfoot: the navicular, cuboid, and three cuneiform bones
Forefoot: the five metatarsals and the bones of the toes
A tailor's bunion develops in the lateral forefoot, around the fifth metatarsophalangeal (MTP) joint at the base of the little toe.
The Fifth Metatarsophalangeal Joint
The fifth MTP joint is formed where the head of the fifth metatarsal meets the proximal phalanx of the little toe. Like the other MTP joints, it allows flexion and extension along with smaller amounts of side-to-side movement.
In a tailor's bunion, the outer aspect of the fifth metatarsal head becomes more prominent. This may result from the shape or position of the fifth metatarsal, an increased angle between the fourth and fifth metatarsals, enlargement of the metatarsal head, or a combination of structural factors. The little toe may also angle inward toward the other toes.
These changes can increase pressure between the outside of the foot and footwear, contributing to irritation, callus formation, tenderness, and pain around the fifth MTP joint.
Looking Beyond the Fifth MTP Joint
Although the symptoms are usually concentrated around the fifth MTP joint, the foot functions as an integrated system. The ankle, subtalar joint, midfoot, forefoot, muscles of the lower leg, and intrinsic muscles of the foot all contribute to how forces are distributed during standing and walking.
For some people, factors such as foot shape, arch structure, pronation or supination patterns, ankle mobility, and the distribution of pressure across the forefoot may be relevant. These relationships vary considerably between individuals, however, and no single biomechanical pattern explains every tailor's bunion.
This is why examination should extend beyond the visible prominence. Foot and ankle mobility, strength, gait, footwear, pressure distribution, and the activities that reproduce symptoms may all provide useful information when developing an individualized management plan.
Why Does a Tailor’s Bunion Develop?
A tailor’s bunion usually develops through a combination of foot structure, anatomy, mechanical loading, and external pressure rather than from a single cause. Some people naturally have a foot shape that makes the outside of the fifth metatarsal more prominent, while others develop symptoms when footwear or activity repeatedly places pressure over this area.
Foot Structure & Anatomy
Several anatomical variations can make the fifth metatarsal more prominent. These may include a wider angle between the fourth and fifth metatarsals, outward bowing of the fifth metatarsal, enlargement of the metatarsal head, or differences in overall forefoot shape.
Conditions such as metatarsus adductus, in which the forefoot is angled inward relative to the rearfoot, may also be associated with bunionette deformity.
These structural characteristics help explain why some people develop a tailor’s bunion even when they wear appropriate footwear.
Footwear & External Pressure
Footwear may not be the sole cause of a tailor’s bunion, but it can have a major influence on symptoms. Shoes with a narrow toe box can compress the forefoot and increase pressure over the prominent fifth metatarsal.
High-heeled footwear can also shift more load toward the forefoot and, when combined with a narrow or pointed toe box, may further increase pressure around the fifth MTP joint.
For someone who already has a structural prominence, changing footwear may therefore be one of the simplest ways to reduce irritation.
Biomechanics & Loading
How the foot accepts and distributes load during standing and walking may also be relevant. Factors such as arch structure, pronation and supination patterns, ankle mobility, forefoot alignment, and pressure distribution across the foot can influence how much load reaches the lateral forefoot.
These relationships are not the same in everyone. For example, pronation should not automatically be considered a dysfunction or assumed to be the cause of a tailor’s bunion. It is a normal component of foot movement, although an individual's movement pattern may become clinically relevant when it corresponds with symptoms or abnormal loading.
Soft Tissues & Joint Function
The muscles, tendons, ligaments, and joint capsule surrounding the fifth MTP joint contribute to movement and stability of the lateral foot. As the structure of the joint changes, these tissues may also be exposed to altered mechanical stresses.
This does not necessarily mean that a particular muscle is “tight” or “weak” and caused the bunion. Instead, soft-tissue and joint findings should be assessed individually to determine whether they are contributing to pain, restricted movement, or impaired function.
Putting the Pieces Together
A tailor’s bunion is best viewed as a multifactorial condition. Foot structure may create the underlying predisposition, while footwear, activity, joint mobility, and individual loading patterns can influence whether the area becomes symptomatic.
This distinction is important because treatment should focus on the factors that can realistically be modified, such as footwear, pressure, mobility, strength, activity, and symptom management, rather than promising to reverse an established structural deformity.
Examination & Diagnosis
A tailor’s bunion can often be identified through the patient’s history and physical examination. Common symptoms include pain or tenderness along the outside of the foot at the fifth metatarsophalangeal (MTP) joint, particularly when wearing shoes that place pressure on the area.
Other findings may include redness, swelling, a visible prominence at the base of the little toe, and callus formation where the foot repeatedly rubs against footwear. Some people experience very little discomfort, while others develop pain during walking, exercise, or prolonged standing.
Physical Examination
Examination should look beyond the visible prominence. The clinician may assess:
The position of the fifth metatarsal and little toe
Tenderness, redness, swelling, or callus formation
Fifth MTP joint mobility and whether movement reproduces symptoms
Overall foot and ankle mobility
Foot shape and alignment
Strength and functional movement
Standing and walking mechanics
Footwear and areas of pressure or irritation
These findings help determine whether the tailor’s bunion itself is responsible for the symptoms and whether other factors may be contributing.
Foot & Ankle Examination
In this video, Dr. Mylonas demonstrates a systematic examination of the foot and ankle, including observation, palpation, range of motion, and orthopedic testing.
A broader examination can be particularly useful because pain along the outside of the foot is not always caused by a tailor’s bunion. Identifying the structure responsible for the symptoms is an important first step in determining appropriate management.
Imagery
A tailor’s bunion is primarily diagnosed clinically, and imaging is not always necessary. When imaging is indicated, weight-bearing X-rays can provide useful information about the structure and alignment of the fifth metatarsal and fifth MTP joint.
Radiographs can help evaluate the shape and position of the fifth metatarsal, the relationship between the fourth and fifth metatarsals, the severity of the deformity, and associated joint changes. They can be particularly useful when symptoms are significant, the diagnosis is uncertain, or surgery is being considered.
Additional imaging is generally reserved for situations in which another condition or associated injury is suspected.
Differential Diagnosis
Not every painful prominence or episode of lateral forefoot pain is a tailor’s bunion. Other conditions that may produce symptoms in this region include fifth metatarsal injury or stress fracture, bursitis, inflammatory arthritis such as gout, osteoarthritis, skin lesions or calluses, and other soft-tissue conditions.
A careful history and physical examination, supported by imaging when appropriate, can help distinguish a symptomatic tailor’s bunion from other causes of lateral foot pain.
Manual Therapy & MSR Treatment
Manual therapy may be incorporated into the conservative management of a symptomatic tailor’s bunion when examination identifies painful or restricted joints, soft-tissue sensitivity, or mobility limitations in the foot and ankle.
Practitioners such as chiropractors, physiotherapists, Registered Massage Therapists, osteopaths, and other appropriately trained healthcare professionals may combine manual therapy with patient education, footwear modification, exercise, and progressive activity according to the individual’s needs.
Manual therapy does not reverse the underlying bony deformity of a tailor’s bunion. Its role is to address modifiable findings that may be contributing to symptoms or limiting function.
Joint Mobilization
Mobilization may be directed toward the fifth MTP joint or other joints of the foot and ankle when clinically relevant restrictions are identified. The goal is to improve available movement, reduce symptoms, and support function, rather than reposition the fifth metatarsal or permanently correct the deformity.
Soft-Tissue Treatment
Massage, Motion Specific Release (MSR), and other soft-tissue techniques may be used to address areas of tenderness, restricted movement, or increased sensitivity in the muscles and connective tissues of the foot and lower leg.
These techniques are generally best considered part of a broader rehabilitation strategy that may also include mobility exercises, strengthening, footwear changes, and modification of aggravating activities.
Treatment should be individualized. Manual therapy may not be appropriate when symptoms suggest fracture, acute inflammatory arthritis, infection, significant vascular compromise, or another condition requiring further medical evaluation.
Treatment Demonstrations
In this video, Dr. Brian Abelson demonstrates MSR procedures directed toward structures that may be relevant when treating a symptomatic tailor’s bunion. Treatment begins at 00:33.
The procedures demonstrated should be selected according to the individual examination rather than applied as a standard protocol for every tailor’s bunion.
MSR Treatment of the Foot
In this video, “Resolve Your Plantar Fasciitis,” Dr. Abelson demonstrates treatment of several structures of the foot and ankle. Although the video focuses on plantar heel pain, some of the examination and treatment concepts may also be relevant when mobility or soft-tissue restrictions are identified in someone with a symptomatic tailor’s bunion.
Fascial Expansion: MSR Foot Pain Protocol
This video demonstrates how fascial expansions are incorporated into the MSR approach to foot pain. The procedure integrates concepts from fascial anatomy and regional biomechanics with selected points traditionally used in acupuncture and Traditional Chinese Medicine, including ST44, LV3, LV2, K3, and BL60.
Within MSR, fascial expansion techniques may be combined with joint mobilization, myofascial procedures, exercise, and other interventions according to the individual’s examination findings.
For a symptomatic tailor’s bunion, these procedures should not be presented as a way to realign the fifth metatarsal or reverse the structural deformity. Instead, they may be incorporated into a broader treatment strategy aimed at managing symptoms, improving mobility, and supporting foot function.
Exercise & Rehabilitation
Exercise can be an important part of conservative care for a symptomatic tailor’s bunion. Depending on the individual examination, exercises may focus on toe mobility, intrinsic foot strength, ankle mobility and strength, balance, and control of the foot during weight-bearing activities.
Exercise cannot be expected to reverse an established bunionette deformity. Instead, the goal is to improve the strength and capacity of the foot and ankle, maintain useful mobility, and help the foot better tolerate walking and other activities.
Targeted Foot & Ankle Exercises
The following exercises are examples that may be incorporated into a rehabilitation program:
Toe Abduction and Adduction: Actively spreading the toes apart and bringing them back together engages the small intrinsic muscles of the foot, including the interossei. This exercise can help develop toe control and intrinsic foot muscle function.
Toe Curls: Controlled toe-curling exercises engage the flexor muscles of the toes and intrinsic muscles of the foot. They can be used to improve toe strength and control, although excessive gripping should be avoided if it increases symptoms around the fifth MTP joint.
Ankle Circles: Moving the ankle slowly through a comfortable range of motion can help maintain ankle and foot mobility. The movement should be controlled rather than forced, particularly when the lateral foot is irritated.
Calf and Toe Stretch: Gentle stretching of the calf and long toe flexors may be useful when examination identifies relevant restrictions. Improving available ankle and foot mobility can help support comfortable movement during walking and other activities.
Towel Scrunches: Scrunching a towel with the toes activates several intrinsic and extrinsic foot muscles. This exercise can be used to develop foot and toe strength and control, provided it can be performed comfortably.
Exercise Demonstration
The exercise demonstrations begin at 04:50. The video demonstrates each of the five exercises described above.
Exercise selection should be based on the individual's symptoms, mobility, strength, functional requirements, and response to loading. Not every person with a tailor’s bunion needs the same exercises, and exercises that consistently increase pain around the fifth MTP joint should be modified or replaced.
Orthotics and Taping
Orthotics and taping may be useful as part of conservative care for a symptomatic tailor’s bunion, particularly when the goal is to reduce pressure around the fifth metatarsophalangeal (MTP) joint and improve comfort during walking or other activities.
Orthotics
Foot orthoses may help redistribute pressure across the foot and reduce loading over the painful lateral forefoot. Depending on the individual’s foot structure, symptoms, and examination findings, an appropriate prefabricated or custom orthotic may be considered.
Orthotics should not be expected to permanently realign the fifth metatarsal or reverse an established bunionette deformity. Their primary role is to modify loading, improve comfort, and support function when clinically appropriate.
Taping
Taping may provide temporary support around the fifth MTP joint or little toe and can sometimes reduce irritation during walking or activity. It may also help determine whether changing pressure or toe position provides meaningful symptom relief for that individual.
Like orthotics, taping does not permanently correct the underlying structural deformity. It is best considered a short-term symptom-management strategy that may be combined with appropriate footwear, exercise, and other conservative treatments.
Individualizing the Approach
Neither orthotics nor taping is necessary for every tailor’s bunion. Their value should be determined by the person’s symptoms, foot structure, footwear, activity demands, and response to the intervention.
Tailor’s Bunion: Putting It All Together
A tailor’s bunion, or bunionette, is a structural change involving the fifth metatarsophalangeal joint at the base of the little toe. Some cause few or no symptoms, while others become painful because of pressure from footwear, activity, or irritation of the surrounding tissues.
Effective management begins with understanding what is contributing to the individual’s symptoms. Foot structure, footwear, joint mobility, strength, activity demands, and the way the foot accepts load may all be relevant.
Conservative care may include footwear modification, exercise, orthotics or taping, activity modification, and manual therapies such as Motion Specific Release (MSR) and joint mobilization when clinically appropriate. These approaches cannot reverse an established bony deformity, but they may help reduce symptoms, improve mobility and function, and keep people active.
When symptoms remain significant despite appropriate conservative care, further evaluation may be warranted to discuss additional treatment options, including surgery.
Ultimately, the goal is not simply to treat the visible bump. It is to understand the person’s symptoms, identify the factors that can realistically be modified, and develop an individualized plan that supports comfortable movement and long-term function.
References
Ewalt, M. E., Jahss, M. H., & Kummer, F. (1993). The Tailor’s Bunion: Anatomic and Clinical Study. Foot & Ankle, 14(6), 335–346.
Mahadevan, D., Attwal, M., Bhatt, R., & Bhatia, M. (2011). The Identification and Management of Bunionette Deformity. The Foot, 21(3), 131–137.
Bertrand, T., & Parekh, S. G. (2011). Bunionette Deformity: Etiology, Nonsurgical Management, and Lateral Exostectomy. Foot and Ankle Clinics, 16(4), 679–688.
Shi, G. G., Humayun, A., Whalen, J. L., & Kitaoka, H. B. (2018). Management of Bunionette Deformity. Journal of the American Academy of Orthopaedic Surgeons, 26(19), e396–e404.
Barnes, D., Matijasich, P., Maxwell, A., Yatsonsky, D., Ballard, A., Ebraheim, N., & Elattar, O. (2024). From Etiology to Intervention: A Holistic Review of Bunion Pathophysiology and Care. Advances in Orthopedics, 2024, 9910410.
Martijn, H. A., Sierevelt, I. N., Wassink, S., Nolte, P. A., & van Dijk, C. N. (2018). Fifth Metatarsal Osteotomies for Treatment of Bunionette Deformity: A Meta-Analysis of Angle Correction and Clinical Condition. The Journal of Foot & Ankle Surgery, 57(1), 140–148.
Del Vecchio, J. J., et al. (2022). Midterm Outcomes of Sliding Distal Metatarsal Minimally Invasive Osteotomy to Treat Bunionette Deformity. Foot & Ankle International, 43(8), 1022–1033.
Lewis, T. L., et al. (2024). Minimally Invasive Surgery for Management of Bunionette Deformity (Tailor's Bunion) Using Fifth Metatarsal Osteotomies: A Systematic Review and Meta-Analysis. Foot & Ankle Orthopaedics.
Disclaimer:
The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
Viewing or using this content does not establish a practitioner-patient relationship. If you have questions about a medical condition or symptoms that are new, severe, or worsening, consult an appropriately qualified healthcare provider.
MSR is not responsible for decisions made or actions taken solely on the basis of this educational content. For complete information about website use, third-party links, privacy, and legal terms, please review the MSR Terms of Use, Privacy Policy, and full website disclaimer.
DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
Continue Learning with MSR Courses and MSR Pro
For Healthcare Practitioners
Motion Specific Release integrates assessment, clinical reasoning, manual therapy, exercise, and patient education within one adaptable approach to musculoskeletal care.
MSR Pro and MSR courses support different parts of that learning process:
Structured Clinical Education: MSR courses connect applied anatomy and biomechanics with orthopedic and neurological assessment, myofascial procedures, fascial expansions, joint mobilization, manipulation, and rehabilitation.
Hands-On Skill Development: Live training provides opportunities to refine palpation, patient positioning, force application, and clinical decision-making through practice and direct feedback.
MSR Pro Clinical Library: Members receive access to more than 200 MSR procedures, downloadable and fillable clinical forms, examination resources, rehabilitation progressions, and exercise-prescription materials.
Extensive Video Resources: More than 800 videos support examination, treatment procedures, exercise rehabilitation, and clinical application.
Patient Education: A library of 50 condition articles helps practitioners explain common musculoskeletal problems and provide patients with practical information.
Continued Development: Resources are updated as MSR courses and clinical education continue to evolve.
Videos and articles can introduce concepts, but hands-on proficiency develops through deliberate practice, feedback, and experience. MSR is designed to help practitioners connect technique with clinical reasoning and adapt care to the individual rather than apply the same protocol to everyone.
Explore MSR Pro | View Online and Live Courses
Comments