Jones Fracture

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The foot is the lowermost point of the human leg. The foot’s overall shape, along with the body’s natural system of balance-keeping, make each person capable of not only walking, but also running, climbing, and countless other activities. The metatarsus of the foot consists of a total of five long bones, which are called metatarsals. Like the metacarpals of the hand, the metatarsals are similarly comprised of a proximal base, a shaft, and a distal head. Along with the tarsals, the metatarsals help form the arches of the foot, which are essential in both weight-bearing and walking.

Below are the five metatarsals described in-depth:

  • First metatarsal – The first metatarsal is the thickest and shortest of the metatarsal group. At the base are usually no facets but oftentimes there is a facet laterally, where it articulates with the second metatarsal.
  • Second metatarsal – The second metatarsal is the longest of all the others and includes four articular facets at its base. These articulate with the medial, intermediate, and lateral cuneiforms as well as the third metatarsal.
  • Third metatarsal – The third metatarsal has a triangular base, which articulates proximally with the lateral cuneiform. Medially, it includes two facets where it articulates with the second metatarsal and laterally it articulates with the fourth metatarsal by a single facet.
  • Fourth metatarsal – The fourth metatarsal is smaller than the third and has three articular facets at its base. It also includes a quadrilateral facet, which articulates with the cuboid. Additionally, there is an oval facet medially that articulates with the third metatarsal and a single facet on the lateral surface of the fifth metatarsal.
  • Fifth metatarsal – The fifth metatarsal has a tuberosity lateral to the base, which can be both seen and felt on the lateral border of the foot. The base articulates with the cuboid proximally by a triangular surface and medially with the fourth metatarsal.

A Jones fracture occurs in a tiny area of the fifth metatarsal that receives less blood and is, therefore, more susceptible to difficulties in healing. A Jones fracture can be either a stress fracture (a small hairline break that occurs over time) or an acute (sudden) break. Jones fractures are generally caused by overuse, repetitive stress, or trauma.

They are less common and more difficult to treat than a similar fracture known as avulsion fractures. In fact, Jones fractures and avulsion fractures both refer to breaks off the same bone, therefore, the differences between Jones and avulsion fractures are small, but also important to be aware of. Other types of fractures may also occur in the fifth metatarsal. Some examples include midshaft fractures, which typically result from trauma or twisting, and fractures of the metatarsal head and neck.

Causes & Symptoms

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Jones fractures are usually caused by overuse and repetitive stress, or by sudden trauma:

  • Overuse and stress – Repeated impacts may result in a hairline fracture of the fifth metatarsal that develops over time. This can be caused by walking, jumping, or running and is often more prevalent in patients with higher arches.
  • Sudden trauma – An acute foot injury such as a turned ankle or twisting fall can also cause a Jones fracture. Sudden traumatic Jones fractures tend to occur when the foot is pointed down and the ankle rolls to the outside. This type of metatarsal fracture frequently affects athletes and is very common among football, soccer, and basketball players.

Stress fractures of the fifth metatarsal can occur due to multiple factors. Unstable foot mechanics and excessive loading of the bone are the two most common elements of this injury. Bones are very resilient, but force can add up rapidly. When running, the force that will travel through the foot is commonly 3-4 times that of your body weight, and when jumping, the total amount of force can be as high as 10-12 times bodyweight.  Other factors that may contribute to a stress fracture include changes in training load and / or frequency, training surfaces, footwear, biomechanical abnormalities.

Another known cause that is involved with a Jones fracture is a ‘displaced’ fracture. A displaced fracture means the pieces of your bone moved so much that a gap formed around the fracture when your bone broke. Non-displaced fractures are still broken bones, but the pieces weren’t moved far enough to be out of alignment during the break. Displaced fractures are much more likely to require surgery to repair, while non-displaced fractures are less likely to need surgical treatment.

A Jones fracture is characterized by increasing pain over the outside of the foot. It normally develops over a period of weeks although sometimes comes on suddenly. The pain is generally very localized over the site of the fracture and worsened by exercise. Other symptoms linked to Jones fractures include:

  • Sharp pain
  • Swelling
  • Tenderness
  • Difficulty walking regularly
  • Limping
  • Bruising or discoloration
  • A deformity or bump that is not usually on your foot.

Who gets Jones Fracture?

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While anyone can sustain a Jones fracture, there are certain activities and risk factors that increase the likelihood of the injury occurring. As the name suggests, Jones fractures can happen from any activity that puts too much stress on a bone, such as a new workout routine. Other causes of Jones fractures include:

  • Change in surface – Going from a soft surface, such as an indoor running track or turf, to a hard surface, such as a sidewalk, can cause stress to the bones of the feet.
  • Improper footwear – Shoes that are ill-fitting, too flimsy, stiff, or worn can contribute to a fracture of the fifth metatarsal.
  • Bone insufficiency – Osteoporosis and low levels of vitamin D can decrease bone density and strength, which may result in an increased chance of experiencing a Jones fracture.
  • Previous stress fractures – Having a previous fracture increases the chances of developing another in the same metatarsal bone.
  • Obesity – Being overweight can put an extreme amount of stress on the feet due to being overweight.
  • A sudden increase in activity – This increase can be in the frequency, duration, or intensity of an activity.

While sports are the most common cause of this injury, non-athletes may also experience them. For example, walking excessively on an uneven surface during a vacation may result in stress to the fifth metatarsal bones.

How does it affect you? How serious is it?

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Jones fractures have a higher chance than other metatarsal fractures of not healing. They also have a higher chance of fracturing again after they’ve healed. In addition, conservative treatments for Jones fracture have a 20% failure rate. Therefore, if the bone fails to heal during treatment, surgery may be necessary.

Reported complications include delays in bone healing, muscle atrophy, and continuing pain. Surgery can cause infection, nerve damage, or further fracturing of the bone during surgery. If you have a high arch or tend to walk putting more weight on the outside of your foot, the stress may cause a break again in the same area. In some cases, people can have foot surgery to change the shape of the foot and reduce stress on the area.

Recommended Treatment & Rehabilitation

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In order to receive an accurate diagnosis for a Jones fracture, a healthcare provider will begin by performing a patient interview and physical examination…

 

Patient interview

In order to make an accurate diagnosis, your physician must know your medical history as well as any known risk factors for developing a Jones fracture. In cases of recurring fifth metatarsal fractures, your physician may order a full medical work-up, which includes blood tests, to help determine if nutritional deficiencies, such as low vitamin D, may be a factor in the injury.

Physical examination

Following a medical history, your physician may perform a physical examination to confirm the diagnosis of a Jones fracture. Usually, this is a simple examination in which the physician applies pressure to the suspected injured bone; If pain or tenderness is reported in response to pressure, a stress fracture is likely the result.

One or more of the following diagnostic imaging exams may be used to confirm the presence of the condition. These include:

  • X-rays – X-rays are normally the first diagnostic imaging tests that are performed. Jones fractures are often difficult to see on X-rays immediately following the injury and may only be noticeable once the fracture has begun to heal, which may be 10-14 days following the onset of pain.
  • Magnetic Resonance Imaging (MRI) – This test uses a powerful magnetic field and radio waves to show a detailed view of the soft tissue surrounding the bone. It can be used to identify abnormalities surrounding a Jones fracture.
  • Ultrasound – Ultrasound is a sensitive exam that can detect fractures in superficial bones.
  • Bone scans – This examination uses a radioactive substance (tracer) that is carefully injected into the bloodstream and a special scanner, which can detect the substance and produce images of bones. A fracture will then appear darker on a bone scan when compared to an uninjured area.
  • Computed tomography (CT) scan – These scans use radiation to create a picture of the bones and joints of the foot and can be used to look for metatarsal fractures as well as to plan the best approach if surgery is ever needed.

As for treatments, this depends on how severe the fracture is. Therefore, your doctor will usually recommend you insert a cast or splint to keep the foot stable. You may also be given crutches to use and keep the weight off your foot for a more rapid recovery.

A Jones fracture may take from 6 weeks to several months to heal. It is very important to give your foot time to heal completely so that you do not hurt it again. It is highly necessary to avoid activities until the foot has been fully recovered and instructed by your doctor when you are free to return to activities. Your doctor may finally suggest that you get physiotherapy to help regain strength and range of motion in your foot.

Furthermore, the basic principles of treating metatarsal fractures include:

 

  • Painkillers – Painkillers such as non-steroidal anti-inflammatory medications (NSAIDs) may help to relieve pain.
  • Stop stressing the foot – If you have been diagnosed with a fifth metatarsal fracture, avoiding the activity that caused it is important for healing. This may mean using crutches or even a wheelchair.
  • Surgery – In severe cases, surgery may be required; for example, to re-align any part of the bone that has moved out of position. However, surgery is not needed for stress fractures.

Exercises may be suggested for a condition or for rehabilitation. Start each exercise slowly while easing off the exercises if you start to have pain. Here are some exercises for you to try:

 

Calf wall stretch

Stand facing a wall with your hands on the wall at about eye level. Put your affected foot about a step behind your other foot. Keeping your back leg straight and your back heel on the floor, bend your front knee and gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg. Finally, hold this stretch for at least 15-30 seconds, then repeat 2-4 more times.

 

Marble pick-ups

Put some marbles on the floor next to a cup. Sit in a chair, and use the toes of your affected foot to lift up one marble from the floor at a time. Then try to put the marble in the cup. It is often recommended to repeat this procedure 8-12 times.

 

Towel scrunches

Sit in a chair and place both feet on a towel on the floor. Scrunch the towel toward you with your toes. Then use your toes to push the towel back into place before repeating 8-12 times.

 

Towel inversion and eversion

Sit in a chair, and place both feet on a towel on the floor. Swivel your feet from side to side to slide the towel. First slide your toes, then your heels, as you move the towel with your feet. Then change directions and swivel your feet from side to side to slide the towel back to the starting position.

Alternative & Homeopathic Treatment

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To help ease your fifth metatarsal pain, it is recommended to try these at-home treatments, such as:

 

Rest

Protect your foot from further injury by not stressing it. Elevate your foot after standing or walking. You might need to avoid your favorite sport for a while, but you can stay fit with low-impact exercises, such as swimming or cycling.

 

Ice application

Applying ice to your foot can be very helpful as a pain reliever. Ice should be applied as soon as possible after injury for 10-30 minutes. Make an ice pack by wrapping ice cubes in a plastic bag or towel, or by using a bag of frozen peas. Gently press the ice pack onto the injured part. The cold is thought to reduce blood flow to the damaged area. This may limit pain, inflammation, and bruising.

 

Wear proper shoes

Avoid too-tight or too-loose shoes and limit your wearing of high heels. Wear shoes appropriate to the sports you play.

 

Metatarsal pads

These pads are placed in your shoes just ahead of the metatarsal bone to help deflect stress from the painful area.