Bursitis of the little toe The outer side of the little toe protrudes outward, with localized skin thickening and callus formation. It often causes localized pain after wearing narrow shoes. Most patients have a combination of bunion deformities, but they can also occur alone. Some patients may have inversion of the little toe. Wearing inappropriate shoes and developmental abnormalities can cause the fifth metatarsal head to protrude outward. If narrow shoes are worn, the local skin is squeezed and rubbed by the shoe surface, resulting in inflammation of the bursa and causing pain. After long-term friction, local skin thickening callus is formed. Wear loose shoes or use foot pads to reduce local pressure. When inflammation occurs, physical therapy and anti-inflammatory and pain-relieving drugs can be used. When non-surgical treatment is ineffective, surgical treatment is available.