Bunionette

Constant irritation of the excessive prominence around the head of the fifth metatarsal bone by tight footwear or increased physical activity causes:

• Troublesome pain
• Excessive skin thickening
• Painful calluses, mainly on the outer side of the foot
• Chronic inflammation on the outer side of the foot at the level of the fifth metatarsal head

It often occurs together with hallux valgus, further widening the forefoot.

Treatment depends on pain severity, how often inflammation recurs around the fifth metatarsal head and whether physical activity must be limited.

Conservative treatment 

The most important step is to eliminate footwear that constantly irritates the fifth metatarsal head. Shoes should be appropriately wider in the forefoot.
Calluses should be removed regularly and suitable orthopaedic aids used to reduce pressure from the shoe against the sensitive area of the fifth metatarsal bone.

Surgical treatment

For large deformities without improvement after conservative treatment, surgery is the only effective treatment.

Diagnostic tests used before bunionette surgery

• Radiographic examination in standard views
• Haematological and biochemical tests (link to preoperative recommendations)
• Pedobarographic examination, still rarely used in Poland, assesses pressure distribution on the soles while standing and walking and allows more precise planning of surgery.
• Ultrasound examination
• Computed tomography
• Magnetic resonance imaging

Before surgical treatment of bunionette, the patient undergoes a thorough examination.

We then discuss the deformity with the patient, explain the proposed surgical options and finally describe the risks of the procedure and possible complications during bunionette surgery.

Depending on the size and type of deformity, various osteotomies (bone cuts) of the fifth metatarsal bone are used to correct it.

These are mainly osteotomies similar in shape to:

• Chevron
• Scarf
• Weil

Minimally invasive techniques are also successfully used in surgical treatment of bunionette deformity – minimally invasive surgery (MIS)Percutaneous osteotomies performed under X-ray guidance make it possible to correct the deformity through a ‘keyhole’, using small skin incisions of approximately 3 mm. 

For postoperative treatment, we use special Postoperative footwear. 

Patients begin walking in them on the first day after the procedure. 
Patients usually wear these shoes for 4–5 weeks.

Rehabilitation is an important element supporting rapid recovery after bunionette surgery. To be effective, it should be based on the following principles:

• the patient’s condition should be assessed
• Individual recommendations should be prepared for the postoperative treatment of bunionette.
• therapy should be adapted to the patient’s abilities

Individual exercises with the patient aim to:

• improve the range of motion in the joints of the operated lower limb
• improve proprioception
• improve neuromuscular coordination
• Reduction of swelling (soft-tissue work, lymphatic massage, kinesiotaping).
• correct gait and faulty movement habits
• physiotherapy

In foot surgery, ensuring a pain-free operation and minimising postoperative pain have always been major challenges.

It is commonly believed that recovery after foot surgery, especially hallux surgery, is very painful.

There are many options for anaesthesia during procedures on the foot.

Modern anaesthesiology aims, wherever possible, to use regional anaesthesia techniques – from central blocks such as spinal and epidural anaesthesia, commonly known as lumbar anaesthesia, to peripheral nerve blocks at various levels performed under ultrasound guidance, especially when operating on one foot.

The possibility of using a particular type of anaesthesia depends mainly on the extent of surgery and any coexisting conditions.

The final choice of anaesthesia is agreed with the patient during the preoperative assessment interview.

Using ultrasound in anaesthesiology to perform peripheral nerve blocks has enabled highly precise regional anaesthesia.

Our many years of experience have changed our perioperative approach, both to anaesthesia itself and to the postoperative period.

For foot surgery, peripheral nerve anaesthesia, known as an ankle block, means injecting a local anaesthetic around the nerves at the appropriate level.

These anaesthetics are highly precise because the nerves responsible for pain sensation are clearly visible on ultrasound and medication delivery is fully controlled.

This can substantially reduce or even eliminate the need for pain medication early after surgery.

For many patients, one of the most important advantages is that sensation above the knee is preserved in the operated leg and, most importantly, lumbar anaesthesia is avoided, which patients do not always accept.

Another important advantage is that walking can begin very soon after the procedure.

During the postoperative period, administering pain medication at regular intervals under ultrasound guidance around the nerves responsible for pain enables patients to pass through this period as comfortably and painlessly as possible.