Fractures of the fifth metatarsal are common injuries. Of all the metatarsal long bones in the foot, the fifth metatarsal is fractured the most at 68% (1). Jones fractures make up 17.5% of foot fractures (2).
The name “Jones Fracture” was named after Sir Robert Jones. He was an Orthopedic Surgeon who recognized fracture patterns occurring at the fifth metatarsal base. He sustained the fracture himself while dancing.
Fractures of the fifth metatarsal should be recognized and treated quickly to ensure the best possible outcomes.
Anatomy of a Jones Fracture
A Jones fracture is a fracture that occurs in the fifth metatarsal base of the foot.
The fifth metatarsal is the metatarsal bone on the outermost aspect of the foot. The fifth metatarsal sits between the 5th toe and the cuboid bone.
The fifth metatarsal provides support and stability during walking and running. It also helps absorb shock during activities.
A “Jones fracture” is a fracture that occurs in the fifth metatarsal base, particularly 1.5cm from the tip of the fifth metatarsal base.
The nutrient artery and metaphyseal arteries provide blood flow to the fifth metatarsal base. Unfortunately, there is a lack of blood flow in the area where a Jones fracture would occur. This is called the “watershed region”. Due to the lack of blood flow in this specific area, Jones fractures can take a long time to heal.
The peroneus brevis tendon, peroneus tertius tendon, and the plantar fascia insert into the base of the fifth metatarsal.
The sural nerve runs along the fifth metatarsal base into the fifth toe.
How Are Jones Fractures Different From Tuberosity Avulsion Fractures?
Both fractures involve the fifth metatarsal bone. However, tuberosity avulsion fractures occur at the tuberosity of the fifth metatarsal bone. Whereas the Jones fracture line occurs 1.5cm further up from this.
Also, the way the fractures occur is different. Fifth metatarsal tuberosity fractures occur from the forefoot being supinated on a plantarflexed foot. This means that the foot is bent down towards the ground and twisted inwards at the same time.
Jones fractures occur from foot adduction on a plantarflexed foot. This means that when you step on your foot, it turns inward and your toes point down. This puts a lot of pressure on the fifth metatarsal bone, causing it to break.
Causes of Jones Metatarsal Fractures in the Foot
As mentioned previously, Jones fractures occur from twisting injuries of the foot. Many athletes have sustained Jones fractures because twisting injuries often occur during sports. These sports include basketball, football, volleyball, track, and soccer. However, these fractures can be seen in any sport.
To read more about Jones fractures in athletes, check out Jones Fractures in Athletes: Risk Factors & Recovery for the Athlete
Falls from heights, direct blows to the foot, and motor vehicle accidents can also cause acute fractures.
What Causes Jones Stress Fractures?
Acute fractures occur from a specific traumatic injury. Jones stress fractures occur from repetitive stress on the fifth metatarsal base. The bone fatigues and eventually cracks, causing a stress fracture.
Activities that place repetitive stress on the bone include running, jumping, and marching.
Certain people are at higher risk for Jones fractures. People who have osteoporosis and diabetes are more prone to developing stress fractures in the foot due to weak bone quality.
Certain foot structures, such as a cavovarus foot, can make you more prone to developing Jones stress fractures.
A cavovarus foot is a type of foot deformity in which the front of the foot is pointed downward and the heel is turned outward. This foot structure would cause you to naturally put more stress on the outside of the foot in the area of the fifth metatarsal base.
Symptoms of Jones Fractures
It’s important to recognize the symptoms of a Jones fracture.
Some of the common symptoms of a Jones fracture include:
- Pain and swelling around the outer midfoot
- Bruising of the foot
- Tenderness along the fifth metatarsal
- Difficulty bearing weight on the foot
- Pain that persists with rest
- A “snapping” or “popping” sound during the time of injury
- Numbness/tingling pain that occurs on the outer midfoot
- Difficulty moving the foot
- Visible deformity of the foot
When to See a Doctor for Acute Fractures of the Fifth Metatarsal
If you sustain an injury and have difficulty bearing weight on your foot, it’s important to see a local foot doctor or go to the Emergency room. Other symptoms that are concerning include persisting pain, swelling, and bruising of the foot.
Your doctor will recommend imaging tests to diagnose the Jones fracture. They will then recommend the best treatment for the fracture. This will help you return to your regular activities as soon as possible.
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- Petrisor BA, Ekrol I, Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int. 2006 Mar;27(3):172-4.https://pubmed.ncbi.nlm.nih.gov/16539897/
- Tu L-A, Knapik DM, Sheehan J, Salata MJ, Voos JE. Prevalence of Jones Fracture Repair and Impact on Short-Term NFL Participation. Foot & Ankle International. 2018;39(1):6-10. https://journals.sagepub.com/doi/10.1177/1071100717733990#:~:text=Based%20on%20data%20from%20the,reported%20in%20the%20general%20population
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