Tailor’s bunion (bunionette): current concepts and outcomes of open versus minimally invasive surgery

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Abstract
Bunionette deformity (BD), also referred to as Tailor's bunion, is characterized by a lateral prominence of the fifth metatarsal head, frequently associated with pain, inflammation, and shoe-related discomfort. This narrative review synthesizes current knowledge on the pathogenesis and clinical presentation of BD, while placing particular emphasis on recent developments in minimally invasive surgery (MIS) techniques compared with traditional open approaches. A narrative review of the literature was conducted using PubMed, Scopus, and Embase databases up to July 2025, focusing on the etiology, clinical presentation, and treatment strategies for BD. Both conservative and surgical approaches, including open and MIS techniques, were critically analyzed. Conservative management, including footwear modification and orthoses, is recommended as first-line treatment. However, no long-term studies have demonstrated sustained symptom relief with non-operative modalities. Surgical options include exostectomy and a range of metatarsal osteotomies (distal, diaphyseal, and proximal), performed via open or MIS techniques. Complication rates in open surgery are reported as highest in proximal (22%) and diaphyseal (21%) osteotomies, followed by distal osteotomies (11%). Revision surgery is more frequent in diaphyseal osteotomies (n = 5; 2%). MIS techniques demonstrate complication rates ranging from 0% to 21.4%, with nonunion rates between 0% and 5.6%. MIS appears to reduce wound-related and hardware complications compared to open techniques; however, direct comparative studies are lacking. While MIS techniques demonstrate favorable complication and recovery profiles in retrospective studies, the lack of high-quality prospective trials prevents definitive conclusions. Future research should prioritize randomized comparative designs to establish clear treatment guidelines.

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