Myelomeningocele

Bunionette (Bunionette)

1) Disease Description (Causes and Symptoms)

• Definition: A condition in which the bone around the little toe (5th metatarsophalangeal joint) protrudes outward or the joint axis widens, causing friction with shoes and resulting in pain. It may occur together with hallux valgus.
• Causes/Pathophysiology: Congenital factors (wide forefoot, anatomical variation of the 5th metatarsal) combined with acquired factors (tight shoes, repeated wearing of high heels) cause lateral protrusion or deformity of the 5th metatarsal axis, leading to inflammation and calluses in the surrounding soft tissues (bursa and skin).
• Main symptoms: Localized pain at the base of the little toe, redness and swelling, callus formation (hyperkeratosis), tenderness when wearing shoes, and worsening with walking.

2) Treatment Methods

• Conservative treatment (early-stage and mild cases)
  • Shoe modification: Wear comfortable shoes with a wide toe box and relatively low heels.
  • Pads/insoles: Use pads to reduce pressure on the protrusion (bunion pads) and custom-made insoles (orthotics).
  • Lifestyle management: Stretch the toes and minimize wearing high heels.
  • Medication: If necessary, NSAIDs may be used to relieve pain and inflammation.
  • Injection treatment: Steroid injections may be considered when acute bursitis is severe (however, repeated injections require caution).
• Surgical treatment (when conservative treatment fails or the deformity is severe)
  • Correct the bony protrusion and axis through exostectomy or osteotomy of the 5th metatarsal. The specific surgical technique is determined according to the degree of deformity.
  • Postoperative care: Depending on the type of surgery, wearing special shoes (usually for several weeks), limiting weight-bearing, and gradually resuming walking and physical therapy.
• Precautions / Risk of complications / Self-management
  • Conservative treatment can help relieve pain but cannot completely correct the deformity itself.
  • Surgical complications: Infection, bleeding, nerve damage (numbness or tingling), delayed wound healing, nonunion/recurrence, and limited joint movement.
  • People with diabetes, vascular disease, or who smoke are at increased risk of delayed wound healing; smoking cessation and management of blood glucose and circulation status before surgery are recommended.
  • Follow postoperative rehabilitation instructions and avoid strenuous activities.

3) Checklist Before an Outpatient Visit (Items to Bring and Things to Confirm)

• Items/materials to bring
  • A list of current medications (especially including anticoagulants, antiplatelet drugs, and steroids)
  • Records of allergies (medications, latex, etc.)
  • History of previous surgeries and medical conditions (diabetes, vascular disease, neuropathy, etc.)
  • Previous test results (if foot X-rays are available, bring the images or report)
  • Pain record: when symptoms began, factors that worsen or relieve them, and pain intensity (pain diary)
  • Photos of the shoes you wear (everyday dress shoes, sneakers, etc.)
• Items the doctor will check during the visit
  • When symptoms began and how they have changed, and their impact on daily life and exercise
  • Whether conservative treatments (insoles, pads, etc.) have been tried and their effects
  • Associated symptoms (foot numbness, decreased sensation, wounds, redness, etc.)
• Necessary tests
  • Physical examination (observing gait and foot shape)
  • Plain X-ray (to assess the degree of deformity and identify metatarsal abnormalities)
  • Additional evaluation for gait analysis and orthotic fabrication if necessary

4) Examples of General Questions to Ask the Doctor

• "What conservative treatments are recommended for my symptoms? How much improvement can I expect?"
• "What are the criteria for needing surgery? What are the advantages and disadvantages of surgery?"
• "What is the expected recovery period after surgery, and when can I return to my daily activities?"
• "Could the medications I am taking (or my underlying conditions) affect the surgery or recovery?"
• "What complications are possible in connection with the surgery, and how likely are they to occur?"

5) Examples of Condition-Specific Questions (1–2)

• "Please explain what type of bunionette I have based on my X-ray results (simple protrusion versus an abnormal metatarsal angle, etc.) and what surgical method would be recommended accordingly."
• "If I manage it with insoles and pads without surgery, how likely are the pain to recur or the deformity to progress? What are the long-term management options?"

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