Medical Terminology for Small Toe Pain
The medical term for pain in the fifth (small) toe depends on the underlying pathology, but the most common condition causing lateral fifth toe pain is "bunionette" (also historically called "tailor's bunion"), which refers to a painful bony prominence on the lateral aspect of the fifth metatarsal head. 1, 2
Specific Terminology by Anatomic Location and Pathology
Fifth Metatarsal Head Pain
- Bunionette deformity describes a forefoot protuberance laterally, dorsolaterally, or plantarlaterally along the fifth metatarsal head, resulting from multifactorial anatomic interplay between fifth metatarsal bony morphology and forefoot soft-tissue imbalance 1
- Friction between the bony prominence, soft tissue, and constrictive footwear causes keratosis, inflammation, pain, and potential ulceration 1
- This condition occurs in many individuals but seldom causes symptoms unless aggravated by footwear 2, 3
Fifth Metatarsal Shaft and Base Pain
- Jones fracture refers to occult fractures involving the fifth metatarsal bone, which can be radiographically occult and require MRI for detection 4
- Stress fracture of the fifth metatarsal presents with progressively worsening pain following increased activity 5
Interdigital Pain (Between Fourth and Fifth Toes)
- Morton neuroma consists of interdigital neuronal thickening and fibrosis, characterized by burning pain in the ball of the foot with numbness or burning that may radiate to affected toes (commonly third and fourth, but can involve fourth and fifth) 6
Clinical Pitfalls to Avoid
Overlooked Concomitant Deformities
- Bunionette deformity is frequently overlooked in patients being treated for hallux valgus, with 7.4% of feet with hallux valgus having concurrent tailor's bunion, and 60.7% of these being missed according to surgical criteria 7
- Patients with hallux valgus who undergo surgery but have undiagnosed bunionette deformity show significantly lower postoperative AOFAS scores compared to those without bunionette (P < .001) 7
Diagnostic Imaging Considerations
- Initial evaluation should include weight-bearing radiographs of the foot as the first imaging study for chronic foot pain of unknown etiology 4
- If radiographs are negative but pain persists >1 week, MRI foot without IV contrast is the appropriate next study for detecting occult fractures, soft tissue pathology, or bone marrow edema 4
Management Algorithm
Conservative Treatment (First-Line)
- Symptomatic bunionettes are usually responsive to nonsurgical management 1
- Footwear modification with advice on shoe wear to reduce friction 3
- Orthotics may be useful if symptomatic bunionette results from excessive subtalar joint pronation 2, 3
- Activity modification and reduction of high-impact activities 8
Surgical Indications
- Operative management is indicated when nonoperative treatment can no longer control symptoms and when the patient has special demands, particularly in sports 2
- Distal osteotomy is recommended if medial translation of the head for one-third of the width of the metatarsal shaft produces a normal fourth-fifth intermetatarsal angle 2, 3
- Proximal osteotomy can correct most deformities and is performed for larger deformities 2, 3