Why is bunion surgery so painful

Tailor's bunion / Digitus quintus varus

A tailor’s bunion is a painful prominence of the fifth metatarsal head that shows changes comparable to hallux valgus. Historically, it is assumed that the tailor practiced his craft in the past centuries, sitting cross-legged, which led to excessive pressure on the outer edge of the foot and a thickened ball of the little toe formed as a result.

Diagnosis / cause

Nowadays the changes, similar to the hallux valgus deformity, are caused by the splayfoot and the protruding fifth metatarsal head on the outer edge of the foot. Shoe problems and tenderness over the ball of the little toe often arise. In addition, the misalignment of the fifth metatarsal bone leads to an axis deviation of the fifth little toe, which can possibly lie under or over the fourth toe (digitus quintus varus) and, in addition to the resulting complaints, is also perceived as cosmetically disturbing. In addition to the clinical examination, the x-ray of the foot while standing shows the extent of the deformity and is used to plan the therapy.



Due to the structural changes, there are hardly any conservative treatment options available here. To avoid the painful shoe conflict, only wider shoes can be worn. If the space available in the shoe is still not sufficient, surgical correction of the position of the fifth metatarsal must be considered if necessary.


A bony intervention on the fifth metatarsal is recommended for permanent correction. Depending on the extent of the misalignment, analogous to the hallux valgus deformity, adjustments can be made close to or away from the joint. The intervention near the joint is carried out using the Chevron surgical procedure. For this purpose, the fifth metatarsal bone is osteotomized (sawed through) near the joint, shifted inward and stabilized with a lag screw.

If there is an axis deviation of the fifth toe (digitus quintus varus), the Lapidus surgical procedure is used. To do this, the extensor tendon of the little toe is transferred to the little toe spreader (abductor digiti minimi) located on the outer edge of the foot in order to rein in the little toe.


The follow-up treatment takes place for 6 weeks in the forefoot relief shoe under full load.

Dr. Esmer would be happy to talk to you personally.