Sunday, June 16, 2024
Forefoot Injuries INJURIES

Jones Fracture or Peroneal Tendonitis: Understanding Both Foot Injuries

What Is a Jones Fracture and What Causes It?

Jones fracture is a foot fracture that was named after the Orthopedic surgeon, Sir Robert Jones. The fracture occurs at the 5th metatarsal bone located about halfway between the heel and the base of the pinky toe.

What makes a Jones fracture unique is the location where the fracture occurs. The fracture occurs at the 5th metatarsal base, where the blood supply to the bone is limited. This makes it more susceptible to damage and delayed healing.

Acute Jones fractures often occur in athletes and active individuals. They are caused by twisting, cutting, and pivoting motions that occur during walking, running, and during certain sports like basketball, football, and soccer.  

The fracture can also be caused by the ankle turning over. This can lead to Jones metatarsal fractures and avulsion fractures. 

An avulsion fracture is when the tendon near the bone pulls away a piece of bone at the time of injury. Avulsion fractures usually occur at the edge of the fifth metatarsal base. Whereas Jones fractures occur slightly further up.

Jones Stress Fracture

Unlike acute fractures, a Jones stress fracture is a type of foot injury that occurs gradually over time due to repetitive stress on the 5th metatarsal bone. Stress fractures often go missed because they develop slowly. 

Stress fractures can occur from activities that cause excess stress on the outside of the foot, such as running, marching, and jumping. 

The repetitive stress on the bone can cause bone fatigue, and thus cause it to crack. Proper shoes and supportive devices can reduce the risk of a Jones stress fracture.

What Is Peroneal Tendonitis and What Causes It?

Peroneal tendonitis is inflammation of the peroneal tendons. There are two peroneal tendons (peroneus longus and peroneus brevis tendons) that course along the outer part of the lower leg and connect to the bones on the outer aspect of the foot. The peroneus brevis tendon, in particular, inserts at the fifth metatarsal base. 

The peroneal tendons are important because they are responsible for stabilizing both the foot and ankle during walking and running. Peroneal tendonitis occurs when the peroneal tendons become inflamed due to repetitive motion and overuse.

Certain foot structures, like overly high arched feet and flat feet, can place extra stress on the peroneal tendonitis and cause them to become inflamed. 

Due to its location in the foot and ankle, peroneal tendonitis can easily be confused for Jones fractures and Achilles tendinopathy.

Symptoms of Jones Fractures in the Foot vs Peroneal Tendonitis

Since Jones fractures occur at the 5th metatarsal base, and the peroneal tendon attaches to the 5th metatarsal base, it can often be difficult to determine which injury you have. 

Here are key differences that can help determine which injury may be present:

Jones FracturesPeroneal Tendonitis
Sudden pain and swelling in the outer footPain and swelling in the outer foot and ankle that occurs gradually 
Pain with activity and restPain with activity but improves with rest
Difficulty bearing weight on the footAble to bear weight on the foot, but instability and weakness of the foot and ankle may be present
Point tenderness along the fifth metatarsal basePain is usually present in both the fifth metatarsal bone and along the ankle
More common in athletes and active individualsMore common in individuals with flat feet or high arches

These are just some of the ways you can determine the difference between a Jones fracture and peroneal tendonitis. If you experience these symptoms, make sure you contact your local foot doctor. 

How Are Jones Fractures and Peroneal Tendonitis Diagnosed?

Diagnosing Jones fractures typically involves a combination of physical examination and imaging tests. 

Your doctor will perform a physical exam and examine the foot for any swelling and tenderness. The doctor may also check for pain when pressure is applied to the affected area or when the foot is moved in certain ways. 

Your doctor will then order an x-ray of the foot. This can be done at the doctor’s office. 

X-rays are often used to diagnose Jones fractures. X-rays can show the extent of the fracture and whether it is displaced or nondisplaced. If the x-ray is inconclusive, an MRI or CT scan may be ordered to provide a more detailed view of the fracture.

Diagnosing peroneal tendonitis also typically involves a combination of physical examination and imaging tests. 

During a physical exam, the doctor will examine the affected foot and ankle for swelling, tenderness, and any deformities. Your doctor will order an x-ray of both the foot and ankle.

While x-rays cannot detect the inflammation of the peroneal tendons themselves, they can help to rule out other conditions, such as fractures or arthritis that can mimic tendonitis. 

If the doctor suspects peroneal tendonitis, an ultrasound, MRI, or CT scan may be ordered to provide a more detailed view of the tendons and surrounding structures. These advanced imaging tests can help to confirm the diagnosis and identify the extent of the inflammation. It can also help to rule out tears of the peroneal tendons.

Treatment

Nonsurgical Treatment for a Jones Fracture

If the Jones fracture is nondisplaced, meaning that there is a fracture but the fracture fragments are well aligned, your doctor will suggest immobilization. 

You will need to stay off of your foot for 8 weeks minimum in a cast or cast boot. Staying off the foot will help the fracture heal appropriately. 

However, it’s important to realize that in some cases, healing can take over 20 weeks due to the poor blood supply at the fracture site.

When Is Jones Fracture Surgery Necessary?

Jones fracture surgery is recommended for active individuals and athletes who need to be able to return to their activities quickly. It is also recommended when conservative treatment options have failed after 6 to 8 weeks. 

If the Jones fracture is displaced, meaning that the fracture fragments are shifted, your doctor will suggest surgery. 

During surgery, your doctor will use plates and screws to stabilize the fracture site. 

After surgery, you will need to stay off of your foot in a cast boot for a minimum of 7-8 weeks before returning to regular activities. 

Treatment for Peroneal Tendonitis

Treatment for peroneal tendonitis includes rest and modifications of activities. When tendonitis is severe, high-impact activities should be avoided for a few weeks until the pain reduces. 

It’s important to ice the foot and ankle, and take anti-inflammatory medications as recommended by your doctor to reduce the pain and swelling. 

If the pain associated with peroneal tendonitis occurs in the ankle, an ankle brace is beneficial because it will help stabilize the ankle and reduce pain. 

If you have a high-arched foot or overly flatfoot that is contributing to the problem, your doctor will suggest custom orthotics to help change how you walk and relieve pressure. Custom orthotics will need to be obtained at your foot doctor’s office.

Rehabilitation for Peroneal Tendonitis

Physical Therapy can also be beneficial in resolving peroneal tendonitis. Your physical therapist will work with you to help improve the strength of your peroneal tendons, improve your range of motion, and decrease inflammation and pain.

Peroneal tendonitis can be treated with rehabilitation exercises that are a vital part of the treatment plan.

Here are some exercises that can be beneficial in enhancing the peroneal tendons’ strength and flexibility:

  • Exercises to improve ankle range of motion: These exercises not only increase ankle range of motion but also build ankle strength. Examples include ankle circles and ankle alphabet exercises.
  • Exercises to strengthen the ankle: Strengthening exercises are important to increase the strength of the peroneal tendons and the muscles that support the ankle joint. Examples of these exercises include calf raises, toe raises, and heel raises.
  • Exercises to improve balance and proprioception: These exercises enhance the balance and stability of the ankle joint, reducing the risk of future injuries. Examples of such exercises include single-leg stance and heel-to-toe walking.
  • Eccentric exercises: Eccentric exercises involve slowly lowering the foot and ankle against resistance. These exercises can help increase the strength of the peroneal tendons and minimize the possibility of future injuries.

Prevention of Injuries

Prevention is key when it comes to avoiding Jones fractures and peroneal tendonitis. Here are some tips on how to prevent these injuries:

  • Wear proper footwear: Make sure you wear shoes that fit well and provide good support. Avoid wearing worn-out shoes or shoes that do not fit properly, as they can increase your risk of foot fractures and tendonitis. You should have your feet measured yearly to ensure you are wearing the right size. Ask your local foot doctor for recommendations on what shoes would be best for your feet. 
  • Wear orthotics: If you have severely flat feet or high arches, this increases your risk for foot injuries. Wearing custom orthotics in your shoes can help redistribute pressure throughout the foot and relieve painful pressure points.
  • Gradual increase in physical activity: If you are an athlete or engage in physical activity, make sure you gradually increase the intensity and duration of your activities to avoid sudden stress on your feet.
  • Stretching and warm-up: Always warm up and stretch before engaging in physical activities. This will help prevent injuries.
  • Cross-training: Incorporate cross-training activities (such as biking and swimming) into your routine to help strengthen the muscles in your feet and prevent overuse injuries.
  • Take rest days: Make sure you take rest days in between activities. This can help reduce inflammation and pain.
  • Proper nutrition: Make sure you eat a healthy diet rich in Calcium and vitamin D to help strengthen your bones and prevent fractures.

Understanding Complications

If left untreated, Jones fractures and peroneal tendonitis can lead to complications. 

Some of the potential complications include:

  • Chronic pain: If not treated properly, both conditions can lead to chronic pain in the foot and ankle.
  • Instability: Peroneal tendonitis can lead to ankle instability if left untreated, making it difficult to walk or participate in physical activities. Untreated Jones fractures will often result in further shifting of the fracture site and cause foot instability.
  • Re-injury: Without proper healing, Jones fractures can lead to re-injury or chronic pain in the foot.
  • Surgery complications: Surgery for Jones fractures can lead to complications such as infection, nerve damage, and nonunion.

To read more about untreated Jones fractures, check out this supplemental article.

When Should You Reach Out to a Health Care Provider if You Suspect a Foot and Ankle Injury?

It is important to reach out to a healthcare provider as soon as possible if you suspect you have a Jones fracture or peroneal tendon injury. These injuries can cause significant pain and discomfort, so it’s important to seek help soon to prevent further complications.  

Reach out to your doctor if you feel sudden pain in the foot, inability to walk comfortably, and if the pain persists for longer than two weeks. The sooner you receive a proper diagnosis the faster you can treat it and continue your normal activities. 

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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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