Types of Bunions: Hallux Valgus, Tailor’s Bunion, and Dorsal Bunion Explained

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Bunion types. Bunions can present as hallux valgus, which refers to a deformity of the big toe.

Another type is called a tailor’s bunion, which involves a deformity of the fifth metatarsal. A tailor’s bunion is also known as a bunionette deformity.

There is also a condition known as a dorsal bunion.

So bunions can be categorized as hallux valgus, tailor’s bunion, or dorsal bunion.

Hallux valgus is a common foot deformity, and there are many misconceptions about it. People often describe it as a bump on the side of the big toe.

This visible bump or bunion is typically associated with several anatomical changes in that region of the foot.

The big toe deviates laterally—meaning it points toward the second toe—causing misalignment of the bones and formation of the bunion.

It is a progressive deformity that may lead to pain, soreness, a burning sensation, inflammation, and redness. Women are more commonly affected than men, especially aging females. Bunions tend to worsen over time and do not resolve on their own.

Symptoms are aggravated by wearing shoes with a narrow toe box or high heels.

The etiology is multifactorial and includes chronic use of tight footwear as well as possible genetic predisposition.

The valgus deviation of the proximal phalanx causes varus positioning of the first metatarsal. This shifts the metatarsal head medially, resulting in lateral displacement of the sesamoid complex relative to the metatarsal head.

Treatment of hallux valgus begins with conservative measures such as shoe modification, pads, orthotic devices, and toe spacers.

Surgical correction is considered if symptoms persist despite nonoperative treatment.

The choice of surgery depends on the severity of the deformity.

Tailor’s bunion, or bunionette deformity, is characterized by prominence of the lateral aspect of the fifth metatarsal head.

It is more common in females.

The condition is usually bilateral and classified into three types.

In type one, the fifth metatarsal head is enlarged, or there may be a lateral exostosis.

In type two, there is bowing of the fifth metatarsal.

Type three involves an increased fourth-to-fifth intermetatarsal angle, which is the most common type.

Initial treatment is nonoperative and includes NSAIDs, shoe modification, and orthotics. Surgery is performed if conservative measures fail to relieve symptoms.

Type one deformity is treated with lateral condylotomy, meaning excision of the bony prominence.

Type two requires distal metatarsal osteotomy.

Type three is treated with oblique diaphyseal osteotomy if the intermetatarsal angle exceeds 12 degrees.

Dorsal bunion develops due to dorsiflexion of the first metatarsal and overactivity of the tibialis anterior muscle. The tibialis anterior is antagonistic to the peroneus longus muscle.

Weakness of the peroneus longus tendon may also contribute to dorsal bunion.

Dorsal bunion can be a residual deformity following correction of clubfoot.

An imbalance between a strong tibialis anterior tendon and a weak gastrocnemius-soleus complex—compensated by overuse of plantar flexors such as flexor hallucis longus and brevis—leads to dorsal bunion formation.

Over time, contracture of these tendons causes plantar flexion of the great toe and a dorsal bunion. Patients often report deformity with dorsal callosities and metatarsalgia.

The first metatarsal shaft is dorsiflexed, and the great toe is plantar flexed, resulting in prominence of the metatarsal head.

Treatment typically includes tibialis anterior tendon lengthening or transfer of the flexor hallucis longus to the plantar aspect of the first metatarsal head. Plantarflexion osteotomy of the first ray may also be considered.

In general, dorsal bunion arises when a normally functioning tibialis anterior overpowers a weak peroneus longus, elevating the first ray. This is commonly seen in patients with a history of clubfoot.

The gastrocnemius-soleus complex is usually weak due to previous surgery, and compensation occurs through plantar flexion of the great toe via the flexor hallucis brevis.