ACORN NEWSPAPER ARTICLE December 1996

When Is A Bunion Not A Bunion

I told her she was in luck. What she had was relatively easy to diagnose and treat. She had a tailor’s bunion. Since Linda was a school teacher I moved into my teaching mode and gave her a pop quiz. I asked her: if a Morton’s neuroma is named after Dr. Morton and Sever’s disease is named after Dr. Sever, how did tailor’s bunion get its name? She bit and tentatively answered: Dr. Taylor?. "Wrong", I said proudly, using the same tone I heard so often when I was in school. It is a foot condition that, like an aviator fracture or basketball heel, is named after an occupation or activity with which it is associated. A hundred years ago, when the disorder got its name, it was the fashion of tailors to sit on the ground crossed legged while they did their sewing. Consequently the outside of the foot, and specifically the head of the 5^th metatarsal, rubbed on the ground with such vigor that it hurt. Linda pointed out that not only is she not a tailor, she doesn’t even own a sewing machine. Like most disorders named after an activity or occupation, most people who have the problem do not participate in the activity. Maybe today it would more likely be named pump wearers bunion.

A tailor’s bunion also goes by the even cuter name of bunionette. It is analogous to the more traditional bunion deformity found on the inside of the foot just behind the big toe. Both are caused by the prominence of an otherwise normal metatarsal bone that has shifted away from the neighboring metatarsals. Initial treatment for both are quite similar as well. Wider and softer shoes can help. Placing pads on or around the bumps can also give relief. Dr. Scholl’s makes a gel-like bunion guard that can be placed over a bunion or a bunionettes to provide temporary relief.

When all else fails, surgery is a great choice for a nagging and persistent tailor’s bunion. The procure takes less than an hour and usually involves both shaving the bump and moving the bone back where it belongs. It is successful more than 95% of the time. I have tried just shaving the bone and not repositioning it with less successful results. It is done with just local anesthesia, usually with a touch of sedation. An hour after the procedure, patients are back at home with their foot elevated and wrapped in ice. Walking can be done immediately as long as a protective shoe is worn for a few weeks. The sutures come out in 10 days and regular shoes are worn as soon as a week or two after that.

Linda, having tried a variety of shoe modifications and pads in the past, elected surgery which was performed earlier this week. The procedure was very successful and she reports virtually no pain. Although I gave her a prescription for some, she has not needed any pain medication. This is not uncommon with tailor’s bunion corrections. It is actually not as painful as a pop quiz. (And if you come to see me about a painful bump on the outside of your foot, you already have the answer.)

Dr. Michael Zapf is a board certified podiatrist with offices in Agoura and Thousand Oaks. For more information you can call his office at (818) 707-3668.

ACORN December 1993

An "Epidemic" of Tailor's Bunions

By: Michael Zapf, D.P.M., M.P.H., F.A.C.F.O

            As I write this there are only three more days of 1993. I hope all of you have experienced a happy holiday season and I wish each and every reader a prosperous and wonderful 1994. Christmas was very special for my family with an 18 month old in the house. Christopher almost knows what is going on. He was certainly intrigued by all of the colored lights and was bound and determined to give each of them a taste test. He is getting quite adept at unwrapping gifts, although the bows and boxes are as exciting to him as the presents. I understand from many of you that this will be the last Christmas where he is unaware of Santa and all that that entails.

            As you might imagine all of your local doctors are spending the last days of 1993 wondering what will become of the practice of medicine starting next year. Certainly the words "managed care" will be on more and more lips. Every month fewer and fewer patients are able to come to a private specialist like myself without at least a referral from their family doctor. This pattern will likely become more the norm than the exception in the future. Until then you can count on your local specialist to provide the most attentive care possible. There has never been a more important time to make patients and referring doctors happy.

            Speaking of referrals, I have had three patients referred to my office in December with tailor's bunions. Usually I only see three people a year with painful tailor's bunions. It looks like a little epidemic.

            A tailor's bunions, also known by the quaint name "bunionette," is a painful swelling behind the 5th toe (the one known to Christopher as the "the little piggy who said 'Whee, whee, whee', all the way home). It is caused by a bone that has become prominent and rubs against the shoe. To counter a common notion, it is not named after a Dr. Tailor  It got its name during the middle ages. Tailor's plied their trade sitting on the ground or floor with their legs crossed. This put the outside edge of the foot against the ground. Hours of sitting for days on end caused the bony prominence to hurt, sometimes excruciatingly. Today we use low and high heeled pumps to accomplish the same thing. The more the trauma of wearing shoes (or sitting cross legged, for that matter) the more pain you get. Eventually it will get bad enough for you to make an appointment (or to ask your doctor for a referral). Then you might end up in my office.

            When these little guys hurt there is not much to do conservatively except relieve the pressure. This can sometimes be done by changing to bigger, wider or more comfortable shoes. I sometimes jokingly tell my patients that they could move to Hawaii and just wear sandals and thongs (shoe variety) for the rest of their livea. However, if the pain persists wearing the shoes you need to wear and doing the things you need to do, then surgery is the answer.

            The surgery is done on an out-patient basis under local anesthesia. A piece of the bone is shaved and the bone itself is often cut and moved over and out of the way. It takes less than an hour to perform the procedure and if both feet have a painful tailor's bunion, they can be done at the same time.

            Surprisingly, there is little pain or disability from this procedure. You do need to wear a post-operative type of shoe for about a month. During this time you are free to be active and can even return to work if the shoe is acceptable to the boss. The procedure is overwhelmingly successful and very gratifying to perform.

            Well, happy new year everybody! And if you see anybody sitting on the ground with their legs crossed and sewing a pair of pants, give them my card.

Dr. Michael Zapf is a board certified podiatrist in practice in Agoura Hills and Thousand Oaks. He is on the active staff of Westlake and Los Robles Medical Centers. For more information please call his office at (818) 707-3668