Tuesday, December 05, 2023
Forefoot Injuries INJURIES

Jones Fracture- Causes, Symptoms, Diagnosis & Treatment

A Jones fracture is an injury that occurs in the fifth metatarsal bone of the foot. The fifth metatarsal is located on the outside of the foot and connects to the pinky toe. The term “Jones fracture” refers to a break at the fifth metatarsal base. It was named after Dr. Robert Jones, a British Orthopedic surgeon who broke his fifth metatarsal base and identified the fracture.

Jones fractures are caused by repetitive stress or sudden trauma to the foot.  Symptoms include pain, swelling, and difficulty bearing weight on the affected foot. When they are left untreated, Jones fractures can lead to chronic pain and other complications.

In this article, we will explore the causes, symptoms, diagnosis, and treatment options for Jones fractures.

fifth metatarsal sawbone

Anatomy 

To understand Jones fractures fully, it’s important to understand the anatomy of the fifth metatarsal. 

There are five metatarsal bones in the foot. The fifth metatarsal is the long bone on the outermost part of your foot. The fifth metatarsal is located between the base of your fifth toe and the cuboid (midfoot bone). 

The peroneus brevis tendon inserts at the base of the fifth metatarsal bone. The peroneus brevis tendon is responsible for the outward motion of your foot. The sural nerve, which is responsible for the sensation on the outside of your foot, courses along the fifth metatarsal. 

The fifth metatarsal can be divided into specific portions: the head, the neck, the diaphysis (shaft), and the base. 

Jones fractures occur in the metaphyseal-diaphyseal region of the fifth metatarsal approximately 1.5cm from the 5th metatarsal tuberosity. 

The blood supply to the fifth metatarsal is supplied by the nutrient artery, the metaphyseal arteries, and the periosteal arteries. 

However, there is a small portion of the fifth metatarsal bone where the blood supply is poor. This is called the “watershed region”. 

This is where Jones fractures occur. 

female running injury

What Causes a Jones Fracture?

Jones fractures can be caused by an acute injury, or by repetitive stress on the bone like in the case of a stress fracture. 

Acute Jones fractures are caused by twisting, falling, jumping, and crushing injuries. Jones fractures are commonly seen in athletes but can occur in anyone who sustains an injury. 

It is commonly seen in sports like basketball and soccer where pivoting motions of the foot can cause injury. 

Jones stress fractures can occur due to repetitive stress being placed on the fifth metatarsal. This can cause the bone to crack over time. 

This can occur in someone who may have increased their training regimen too soon. Certain activities such as marching, running, and prolonged hiking place you at a higher risk for developing stress fractures. 

Certain foot types can also make you more prone to getting Jones stress fractures. 

For instance, if you have a metatarsus adductus foot structure, you have a much higher likelihood of sustaining a Jones fracture. 

A metatarsus adductus foot structure is where the front portion of your foot (forefoot) turns inward. This foot structure naturally predisposes you to put more pressure on the outside of the foot when you walk. 

Check the bottoms of one of your worn shoes. Do you notice more shoe wear on the outer portion of your forefoot? You may have a metatarsus adductus foot structure or a “supinated foot.” 

This can place you at higher risk for developing a Jones stress fracture due to more pressure being placed on the outside of your foot. 

How Common Is a Jones Fracture?

Fifth metatarsal fractures account for 68% of metatarsal fractures (1). Jones fractures are commonly seen in males in their mid-twenties and women over the age of seventy. 

However, these fractures can occur on anyone.

swollen foot

How Do You Know if You Have a Jones Fracture?

While Jones fractures can be a serious injury, they are often overlooked or misdiagnosed, which can lead to chronic pain and complications. To help you identify a Jones fracture, it’s important to know the symptoms. 

If you experience any of the following, you may have a Jones fracture:

  • Immediate sharp or dull pain to the side of the foot
  • Foot swelling
  • Bruising in the foot
  • Inability to bear weight on the foot
  • Inability to push your foot outwards
  • Pain that doesn’t improve with rest
  • A bump on the outside of your foot
  • A visible deformity in the foot
jones fracture xray

How Is a Jones Fracture Diagnosed?

If you sustain an injury, you should go to the emergency department or visit a local foot doctor. 

Your doctor will perform a history and physical exam. Your doctor will be checking if there are any tears in the skin to rule out open fractures.

Your doctor will check your pedal pulses (dorsalis pedis and posterior tibial pulse) to check if the blood flow to your foot is good. 

Your doctor will order x-rays of your foot to identify the fracture. If your doctor suspects that you may have a stress fracture, it may not be visible on an x-ray initially. 

Stress fractures can take up to three weeks to show up on an x-ray. In this case, your doctor will order repeat radiographs 3 weeks after your initial visit to confirm the presence of a stress fracture.

Occasionally, a Computed Tomography Scan (CT scan) may be ordered to evaluate the fracture site more extensively. CT scans provide detailed images of the fracture as well as cortical bone. 

If your doctor suspects tendon injury, he/she may order an MRI. An MRI provides detailed images of soft tissue structures, in addition to bone. 

A bone scan can also be used to identify Jones fractures. 

Fractures that may not be fully visible on an x-ray (like in the case of a stress fracture) can be identified on a bone scan. 

Related article: Jones Fracture Diagnosis: How To Identify This Common Foot Injury

surgery

How Do You Treat a Jones Fracture?

Non-displaced Jones Fractures

If the Jones metatarsal fracture is nondisplaced (broken but in proper alignment), your doctor may recommend that you remain non-weight bearing in a cast or cast boot for 8 weeks minimum

Fracture healing typically takes 8 weeks. However, Jones fractures can take the full 8 weeks or longer to heal due to reduced blood supply in the area of the fracture. 

Your doctor will order x-rays every 3-4 weeks to assess the fracture site and make sure it is healing. If your fracture hasn’t healed in 8 weeks, you may need surgery to repair the fracture site due to delayed healing. 

Stress fractures can often be treated non-surgically. If the stress fracture is immobilized quickly, it has a greater potential to heal. 

If you’re an athlete and are very active, your doctor may recommend surgery for a non-displaced fracture. This is because Jones fractures heal faster after surgical repair.

Displaced Jones Fractures

If the Jones metatarsal fracture is displaced, your doctor may suggest surgery

A displaced fracture is when the bone is broken and a gap exists between the fracture fragments.  

Jones fracture surgery would be done in the operating room under anesthesia. 

Your doctor will repair your fracture using a single screw, or plates/screws. Occasionally, a bone graft may be taken from your heel bone and inserted into the fracture site to allow for the fracture site to heal faster. 

You will need to stay non-weight bearing in a cast for up to 6-8 weeks after surgery. 

Your doctor will order x-rays in the office every 3-4 weeks to assess bone healing. 

Once the fracture has nearly healed, your doctor will allow you to transition into wearing athletic shoes.  

Complications of Jones Fracture Surgery

Non-union 

A nonunion occurs when the bone fails to heal properly after surgery. Treatment options for non-union may include bone grafting or the use of electrical stimulation to promote bone growth.

Delayed Union

A delayed union occurs when the bone takes longer than expected to heal after surgery. Treatment options may include the use of a bone stimulator and prolonged immobilization. 

Hardware Complications

This complication can occur when the screws or plates used to stabilize the bone become loose, break, or cause irritation. Treatment would involve surgical removal of defective hardware

Numbness

Numbness in the foot can occur as a result of nerve damage during surgery. In some cases, the numbness may improve over time, while in others, it may be permanent.

Nerve Injury 

Injury to the nerves in the foot can occur during surgery and may result in burning, tingling, and numbness. Treatment options may include nerve grafting or the use of electrical stimulation to promote nerve regeneration.

Infection

Infection is a risk with any surgical procedure. Treatment may involve antibiotics and in some cases, additional surgery to remove infected tissue.

Continued Pain

Despite successful surgery, some patients may continue to experience pain at the site of the fracture. Treatment would involve physical therapy, medication, and in some cases, revision surgery.

Swelling

Swelling is a common complication after Jones fracture surgery and may be managed with rest, ice, compression, and elevation of the affected foot. Swelling may be present for several months after surgery.

How Long Does Swelling Last After a Jones Fracture?

Swelling from a Jones fracture can last for 3-6 months. If you undergo Jones fracture surgery, foot swelling from the surgery can last up to a year. Compression stockings can help reduce swelling in the foot after surgery. 

driving

Can I Drive With a Jones Fracture?

If you have a Jones fracture on the right foot, you should refrain from driving for  6-8 weeks minimum while the bone is healing. You should not drive while wearing a cast or cast boot. This is a safety hazard while driving. 

Also, you should not be driving if you are taking narcotics. 

If you have fractured your left foot and are not on narcotics, talk to your doctor about whether you can drive. 

Your doctor may still recommend that you not drive for a few weeks so that you can elevate your left foot and reduce the risk of injury. 

What Will Happen if a Jones Fracture Goes Untreated?

Ignoring a Jones fracture can lead to serious consequences. If left untreated, the fracture may not heal properly, resulting in a painful non-union. 

Furthermore, continued weight-bearing on the foot can cause the fracture to displace further, leading to chronic pain and deformity. This can significantly limit your daily activities, making it difficult to perform even the simplest of tasks. 

In some cases, surgery may be necessary to correct the damage caused by an untreated Jones fracture. Therefore, it’s crucial to seek medical attention as soon as possible if you suspect you may have a Jones fracture.

When Can I Wear Heels After a Fifth Metatarsal Fracture?

After a fifth metatarsal fracture, you may be wondering when it’s safe to start wearing heels again. While everyone’s healing process is different, it typically takes a minimum of 8-12 weeks for the bone to fully heal and for you to be able to wear heels comfortably. 

This is because high heels put pressure on the forefoot, including the fifth metatarsal, which can impact the healing process and lead to discomfort. It’s essential to wait until you can walk comfortably without pain before transitioning back to high heel shoes. 

man tying shoes

How You Can Prevent Jones Fractures

Wear Appropriate Shoes During Activities

Wearing shoes that are well-fitted for your feet can help prevent injuries. Go to a shoe store at the end of the day when your feet are the most swollen. Have your feet measured for length and width. 

Talk to your foot doctor or shoe sales representative about what shoes they recommend for your foot structure.

Wear Orthotics

If you place a lot of pressure on the outside of your feet when you walk, talk to your foot doctor about custom orthotics. Remember, excess pressure on the outside of the foot is what causes Jones stress fractures to occur.

Orthotics can help rebalance the pressure on the bottom of your foot.  Over-the-counter orthotics can work well, but custom orthotics are custom-made to your feet and are more beneficial in this case.

Increase Training Slowly

To avoid stress fractures in the foot, avoid training extensively in a short period. If running, aim to increase your mileage slowly. If you have foot pain, stop high-impact activities and ice the foot. 

Cross-Train

If you run every day and have foot pain, you should try cross-training activities such as swimming and even biking. This can help decrease the load on the outside of your foot. 

Replace Worn Shoes

Check the bottoms of your shoes for wear. Do this monthly. If your shoes are worn, throw them out and replace them. 

Break into your new pair of shoes slowly. 

Conclusion

In conclusion, Jones fractures can be incredibly difficult to heal and should be addressed quickly. Although Jones fractures can be treated non-surgically, there are some instances where surgery may be a better option. If you suspect you have a Jones fracture, contact your foot doctor immediately. 

Related article: Dancer’s Fracture: Causes, Symptoms, Diagnosis & Treatment

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jones pin

References

  1. 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/
  2. Kavanaugh, J. H., Brower, T. D., & Mann, R. V. (1978). The Jones fracture revisited. jbjs60(6), 776-782.https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.860.3380&rep=rep1&type=pdf
  3. Fleischer, A. E., Stack, R., Klein, E. E., Baker, J. R., Weil Jr, L., & Weil Sr, L. S. (2017). Forefoot adduction is a risk factor for Jones fracture. The Journal of Foot and Ankle Surgery56(5), 917-921.https://www.sciencedirect.com/science/article/abs/pii/S1067251617302685
  4. Albloushi M, Alshanqiti A, Qasem M, Abitbol A, Gregory T. Jones type fifth metatarsal fracture fixation in athletes: A review and current concept. World J Orthop. 2021 Sep 18;12(9):640-650.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8472442/
  5. Dean, Benjamin & Kothari, Alpesh & Uppal, Harpal & Kankate, Raghubir. (2012). The Jones Fracture Classification, Management, Outcome, and Complications: A Systematic Review. Foot & ankle specialist. 5. 256-9. 10.1177/1938640012444730.https://www.researchgate.net/publication/224871144_The_Jones_Fracture_Classification_Management_Outcome_and_Complications_A_Systematic_Review 

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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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