Quintus Varus, affection of the fifth toe “bunionette”

The symptoms are: pain and stiffness with very often the formation of a skin thickness a horn also known as hyperkeratosis on the dorsal side and on the lateral face of the 5th toe. There is also the formation of keratosis tumefaction sensitive to touch and painful to walking.

What is the exostosis?

At the end of the evolution of this allocation, A “bump” also forms “exostosis” on the lateral side (external) of the head of the 5th toe metatarsal.
It may also be accompanied, in some cases, by redness called “inflammatory bursitis” or “ulcerative bursitis”.
V.Q. Can sometimes be the cause of lameness and dilemma in the footwear. The shoe becomes painful to bear, causing rubbing on contact with the bone. V.Q. May be accompanied by a plantar callus. When the deformation becomes advanced, it is associated with a grae, with a retraction of the extensor of the fifth and plantar flexion of the distal phalanx, and in a still more advanced stage, one can find a wound and sometimes a seepage.

V.Q. Infradductus or supradductus?

We distinguish the QV, deformations with conflict between the 4th and 5th toe. It is called “Infradductus Varus quintus ” or ” Supradductus Varus Quintus “(see drawing above). On clinical examination, the deformation is then either reducible ie the passive manipulation of the toe makes it possible to mobilize it and to lengthen the toe; Is irreducible with the impossibility of lengthening the toe.
In some cases, V.Q. may associate with Hallux valgus. It is in these forms that there are areas of friction between the lateral face of the fourth toe (outwards) and the medial side of the fifth (face looking at the big toe). This zone of friction can, if the 4th toe is stiff, also result in the formation of a “partridge eye” which is a painful chronic lesion, sometimes exposing the bone and likely to result in “osteitis” which is A formidable complication to cure and cure.
There is an enlargement between the 4th and 5th radius with an angle M4-M5 greater than 10 °. V.Q. may complicate a diabetic foot or neuropathic foot.


Additional information

Conservative medical treatment?

As long as the deformation is reducible, one can try a so-called conservative treatment:

  • Associated Drug Therapy NSAIDs and Analgesics
  • Pedicure for Keratoma,
  • Orthopaedic insoles,
  • Orthoplasty (see photo above).

Surgical treatment?

  • Tendinous elongation more simply Transcutaneous tenotomy of one or more toe tendons: extensor and / or flexor (see photo above).
  • Resection of the lateral exostosis of the 5th metatarsal head.
  • Osteotomy of one or two bones of the 5th ray (M5 +/- P1):

The exostosis removal: Exostosis is a source of friction, bursitis and pain. In many cases, it seems to be the reason of the pain. This can be supplemented by a bone realignment by osteotomy which must reduce the value of the angle M4-M5 to less than 10 °. By a 2 or even 3 osteotomies: on M5, on P1 of the 5th toe and / or on P2 of the 5th.

  1. Supradductus Quintus varus: Deformation of the fifth toe with a conflict between the 4th and 5th toes leading to an overlap of the 5th on the 4th.
  2. 1Infradductus Varus Quintus: Deformation of the fifth toe with a conflict between the 4th and the 5th toe resulting in an overlap of the 4th on the 5th toe
  3. Exostosis: Bone protrusion at a distance from the joint its formation is related to the excess friction of the bone against a rather rigid body the shoe for example
  4. Cor: Hard skin formation consisted of superficial epidermal tissue
  5. Partridge interdigital eye: Created by the friction between the 4th and 5th toe is treated by pedicure care at the start and then surgical
  6. Hyperkeratosis: Apposition of keratin which tends to strengthen the skin in the conflict in reaction of a friction, it is a first sign of cutaneous suffering translating a mechanical cause
  7. Keratome: Thick skin formation and sometimes dark mediane perforation
  8. Osteotomy: Section of the bone in order to straighten an axis, is done with the surgical saw, or by weakening the bone by perforations all around the bone making the bone correction possible by a simple manual effort of tensioning . It is a kind of therapeutic fracture
  9. MTP: Metatarso-phalangienne articulation
  10. Inflammatory bursitis: Is a formation of a serous purse containing liquid and testifying to skin suffering caused in general by a mechanical friction process
  11. Ulcerative Inflammatory bursitis / Skin that becomes thinner and can perforate it can give rise to so poorly treated to an underlying osteitis
  12. Osteitis bone infection: Is a complication of deformity that can become serious