Bursitis of the little toe The inversion of the little toe, the lateral protrusion of the bone of the 5th toe, the formation of a bursa and inflammation is called bursitis of the little toe. Many patients often complain of pain in the lateral aspect of the little toe when wearing narrow shoes. Examination may also reveal outward protrusion of the 5th metatarsal head, localized thickening of the skin, callus formation, and even redness, swelling, and pain. Some patients also show callus formation on the metatarsal side of the 5th metatarsal head. Bursitis of the little toe may occur alone or in combination with a bunion deformity. Some patients may have inversion of the little toe. The fifth metatarsal head may protrude outward due to inappropriate shoes and developmental abnormalities. If you wear narrow shoes, 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. On the X-ray, the 5th metatarsal bone may have 3 kinds of manifestations: 1) the lateral enlargement of the metatarsal head; 2) the marked increase of the angle between the 4th and 5th metatarsals; 3) the outward curvature of the 5th metatarsal stem. If the 1st and 2nd intermetatarsal angles are greater than 10 degrees, and the 4th and 5th intermetatarsal angles are greater than 5 degrees, it is called scalloped foot. However, the 4th and 5th intermetatarsal angles are often greater than 10 degrees when the bursitis of the little toe is manifested. Treatment 1.Non-surgical treatment Change to loose, soft shoes or use foot pads to reduce local pressure. When local inflammation occurs, physiotherapy and anti-inflammatory and pain-relieving drugs can be used. 2.Surgical treatment When non-surgical treatment is ineffective, the bone can be removed surgically or the metatarsal osteotomy can be done. Chevron osteotomy can be used to correct the formation of the 5th metatarsal head lateral superfluous bone and callus. In the case of callus formation on the metatarsal side of the 5th metatarsal head, Wilson’s osteotomy can be used. If the angle between the 4th and 5th metatarsal bones is significantly increased, the 5th metatarsal stem or base osteotomy is required.