Tailor’s bunion surgery: A guide for patients

A Tailor’s bunion is when the fifth metatarsal bone deviates towards the outside of the foot. This can produce friction from footwear, which can lead to corns and callus forming. A Tailor’s bunion can also be associated with a deformity of the little toe.

Treatment options

Depending on the degree of pain, prominence of the joint and the extent of involvement of the little toe, there are several treatment options:

Non-surgical treatments

• Joint padding and protective shields
• Gel/silicone wedges between the toes
• Avoid high heeled shoes
• Surgical footwear
• Insoles (orthoses).

Surgical treatment

The aim is to reduce the prominence of the joint/bone, as well as addressing any toe deformity.

To correct the deformity, an incision is made along the outside of the foot to expose the bone. The bone is then cut and repositioned and secured with screws or plates.

About day surgery under local anaesthetic

Surgery is carried out under local anaesthetic as a day case. This means that you are awake during the operation, but a screen will prevent you from seeing the operation.

To numb your foot you will be given some injections around your ankle or behind the back of the knee.

You can eat and drink on the day of surgery; there is no need for fasting.

The operation may take up to 40 minutes but you should be prepared to be at the hospital for longer than this to allow for preparation and recovery.
Throughout the operation you will generally have a tight band around the ankle to keep the blood away from your foot. This can be uncomfortable, but is immediately released after the operation.

You must have a competent adult at home for the first day and night after surgery.

If you decide on surgery you will be invited to a pre-surgical clinic. A member of the nursing team will take your medical history. If you are on any medication, please bring a list with you. This is a good opportunity to ask us any questions and discuss any concerns you may have.

Recovery after your operation

The first two to three days

• You must rest with your foot elevated to hip level.
• You should restrict your walking to bathroom visits only. If you have been given crutches, you must use them in the way shown. You may be able to bear a little weight on the foot.
• You should take the prescribed painkillers. If you experience pain, it is usually worse for the first two days.
• If you are still experiencing pain after three to four days that is not relieved by the painkillers, you should contact the department directly.
• If you have any concerns regarding your foot you should contact the department directly.
• The department is closed at the weekend. Out-of-hours you should contact your GP or go to your local accident and emergency (A&E) department.

Two weeks after surgery

• Two weeks after the operation you must visit for the dressing and stitches to be removed.
• You should no longer need a bandage and will be able to wear a trainer type shoe. This shoe needs to be roomy because your foot will be quite swollen. If you do not have any, you will need to buy some before surgery.
• At this stage you can gradually and gently increase your activities. You will still need to rest between activities.
• You will also be given a rigorous regime of exercises to regain strength and flexibility in the toe joint.

Between two and six weeks after surgery

• You can normally start bathing the foot again one to two days following stitch removal.
• During this time the foot gradually returns to normal and you may be able to vary your footwear a little. Sixty per cent of patients have returned to roomy shoes at six weeks, and ninety per cent in eight weeks.
• There will still be noticeable swelling, especially towards the end of the day. This is quite normal.
• You may also return to work after six weeks, depending on the type of work and footwear in which you are allowed to return. For certain jobs, this could be an unrealistic expectation.
• At six weeks you can begin driving; however, you must feel able to perform an emergency stop. Please check with your insurance company about when your policy covers you to drive.
• Although normal everyday activities will be possible, sporting activities are still restricted.

Between six and twelve weeks after surgery

• The foot should now be comfortable and returning to normal, but there may still be some slight swelling.
• You can return to sporting activities/gym work at 12 weeks.

Six months after surgery

• The residual swelling should now be very slight, although the healing process continues for a year. You should be getting full benefit from the surgery.

Twelve months after the surgery

• All healing is now complete.

Frequent or serious occurring risks

All operations carry a small risk of complications. In foot surgery, complications are uncommon and most are resolved without permanent disability or pain. General and specific complications of this procedure include:

• infection (two in 100)
• delayed healing of the skin (eight in 100)
• non-union of bone (15 in 1,000)
• bone fracture associated with non-compliance (two in 100)
• prolonged swelling post operatively (four 100)

• thick or sensitive scar formation (four in 100)
• loosening or movement of the screw or wire used to fix the bones (two in 100)
• shortening of the toe
• the toe may become stiff (one in 100)
• toe does not touch ground - floating toe (this can often be solved by stretching exercises)
• transfer pain / lesion to adjacent joints in the ball of the foot
• blood clot deep vein thrombosis (DVT).

Complications following foot surgery are rare but can happen. It is important to remember that if a complication arises, you will need to visit the hospital more frequently and there could be a significant impact on your recovery and return to work time. Foot surgery should be avoided if only for cosmetic gain.