A Jones fracture is a crack in the bone at the 5th metatarsal or little toe. The 5th metatarsal fracture occur at the base of the bone in the lateral mid-foot. So, why is a Jones fracture essential to diagnose, and what should you do about it?
What are the causes of Jones fracture?
Jones fracture, or 5th metatarsal fracture, can be caused by an acute injury such as an ankle twist or chronic overload. However, it can also occur without an acute injury. Repetitive and excessive load can weaken the bone, causing a stress fracture.
A Jones fracture of foot occurs at the metaphyseal-diaphyseal junction about 1.5cm from the tip of the base. It appears in the region of the bone with a limited blood supply. As such, healing is slowed and delayed.
Diagnosis of Jones Fracture of Foot
Generally, Jones’s fracture of foot presents as acute pain in the outer part of the mid-foot. They also report swelling and difficulty with weight-bearing.
Typically, there is tenderness at the 5th Metatarsal or little toe base.
Overall, investigations are essential to confirm the diagnosis and exclude other causes of pain outside the mid-foot. An X-ray can localise the site of the fracture.
Importantly, your doctor needs to differentiate a Jones fracture from other fractures of the 5th Metatarsal. A Jones fracture occurs in the zone between the shaft and the tip of the bone. This fracture is different from other fractures in the little toe. For example, ankle sprains cause avulsion fracture of the 5th Metatarsal. These fractures heal well in a walking boot. Also, Dancer’s foot corresponds to a fracture of the middle of the 5th metatarsal bone. Similarly, treatment is a boot unless the fracture ends are significantly displaced.
What should you do about a Jones fracture?
When you’ve confirmed a diagnosis of a Jones fracture, you need to decide on management. Generally, Jones fractures are slow to heal because of reduced blood supply. Therefore, your doctor should discuss the pros and cons of the different treatments.
Non-operative treatment
Generally, non-operative treatment consists of protected weight-bearing in a CAM walker boot. Patients use crutches for the first few weeks. The CAM walker boot is used continuously for the first six weeks. After six weeks, People can remove the CAM walker boot and slowly move into weight-bearing activities as the fracture heals. Transitioning from walking boot to shoe takes about two weeks. Then, movement can progress gradually from walking to running. It is essential to monitor with X-rays to ensure healing.
Other treatments that enhance bone healing include optimising Vitamin D and calcium intake, focused shockwave therapy, and LIPUS therapy. Sometimes, we perform other tests to assess bone health, including blood tests and a bone density scan.
In total, patients often require three months for complete healing.
Surgery
Generally, we consider immediate surgery for athletes with a Jones fracture to avoid delayed union and non-union. However, surgery also has risks and has to be weighed against the concerns of prolonged healing and non-union with conservative management.
Typically, the most common bone fixation method is using an intra-medullary bone screw, which provides faster fixation. Plates and screws are used in displaced fractures and take longer to heal. Sometimes, bone grafting is used to optimise bone healing.
Other Frequently Asked Questions about a Base of 5th Metatarsal Fracture
How to increase blood supply to Jones fracture?
As the blood supply is limited, it is essential to optimise bone healing through various methods, including vitamin D and calcium optimisation, focused shockwave therapy, and LIPUS therapy.
How long does a Jones fracture take to heal?
If treating the fracture without surgery, healing can take about 2-3 months. Surgery with screw fixation+/- bone grafting will take about the same time to heal.
Can a Jones fracture heal in 4 weeks?
Generally no. It usually takes at least 8 weeks for the fracture to heal, irrespective of whether treatment is non-operative or operative.
Final word from Sportdoctorlondon about a Jones fracture
Overall, we need to be careful when fractures occur in the fifth toe. However, if the fracture occurs at the base of the fifth metatarsal, you should see a Sports Medicine expert who can guide you through proper treatment.
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