A Jones fracture refers to a break between the base and shaft of the fifth metatarsal bone of the foot. The fifth metatarsal is the long bone on the outside of the foot that connects to the smallest toe.

A Jones fracture is a common type of metatarsal fracture that occurs in the bone on the outer side of the foot. This fracture takes its name from the orthopedic surgeon, Sir Robert Jones, who first reported and treated the injury in 1902.

This article discusses what a Jones fracture is, the treatment options, and the recovery process.

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A Jones fracture is a common foot injury that describes a fracture at the base of the fifth metatarsal, which is the long bone that runs along the outside of the foot from the smallest toe to the ankle. The fracture occurs in the area between the base (metaphysis) and shaft (diaphysis) of the fifth metatarsal, known as the metaphyseal-diaphyseal junction.

Typically, this type of fracture results from stress on the bone caused by repeated motion, but it may also result from overuse or a sudden acute injury. It is a common injury in many athletes. However, as the area receives less blood than other regions of the foot, it can make healing difficult.

What are metatarsals?

The metatarsal bones are the long bones of the forefoot that connect the ankle (cuboid and cuneiform bones) with the toes (phalanges). There are five metatarsals in each foot. Each metatarsal bone has a base located next to the heel, a shaft, a neck, and a head.

The metatarsal have a number from one to five, from the big toe to the small toe. The fifth metatarsal is the metatarsal on the outside of the foot that connects the ankle with the little toe. It is slightly different from the other metatarsal bones. It bulges slightly at its base, while the other metatarsals do not.

The metatarsal bones help people balance while standing and walking. As these bones get much more use than other bones, it is easy to injure them through overuse. Sudden acute injuries of the metatarsals are common after a sudden impact or severe twist of the foot.

Treatment will depend on several factors, including the:

  • individual’s activity level
  • severity of the break
  • overall health of the person

In some cases, an orthopedic surgeon may initially recommend treating a Jones fracture without surgery. Often, this will involve an individual wearing a non-weightbearing cast or boot or using crutches to assist with walking. The healing period can range from 6 weeks to a few months. Additionally, a surgeon may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and the RICE method to reduce swelling. The RICE method involves:

  • Resting the injury.
  • Icing areas of pain and swelling with an ice pack or ice wrapped in a cloth.
  • Compressing the affected area with an elastic wrapping.
  • Elevating the injured foot above the level of the heart.

While a Jones fracture is often slow to heal, in some cases, it may not heal at all. There is also a risk of reinjury. As such, a doctor may suggest repeat X-rays to monitor recovery and ensure appropriate healing. If the fracture does not appear to be healing, then a doctor may recommend surgery.

The surgical incision necessary to repair a Jones fracture is minimal. This means that the surgeon can operate on a person on an outpatient basis, using general or local anesthesia. Surgeons commonly repair these fractures by inserting a screw, rod, or plate. During the procedure, the surgeon uses X-rays to ensure proper screw placement. The screw crosses the site of the fracture and squeezes the ends of it together.

Sometimes, a person may need a bone graft, particularly if they have experienced repeated fractures that have not healed with other treatment. In these cases, a surgeon may need to make a separate incision to perform the bone graft.

A Jones fracture has many of the same symptoms as other types of fractures. A person with a Jones fracture may know they have injured their foot right away if the injury is sudden and causes immediate symptoms. However, some people may not experience pain, even with weight bearing.

These symptoms can include:

  • pain and swelling on the outside of the foot at the base of the little toe
  • problems walking
  • bruises

A Jones fracture will usually take about 6 weeks to heal. However, a person may still experience pain and swelling for 3–6 months. Often, a person will wear a boot or cast and initially attempt to keep their weight off the foot. They may also take pain killers to help with any pain. A doctor may also advise using some ankle and foot exercises to encourage healing and help with the range of motion.

During this recovery period, a doctor will assess how the fracture is healing and whether a person will require surgery. If surgery is necessary, it may take roughly 8 weeks to recover.

After the fracture heals, a person may be able to resume normal activities. However, some arduous tasks may cause discomfort. Athletes may consider wearing a clamshell orthosis or turf toe plate when returning to sports.

In addition to Jones fracture, there are other types of fifth metatarsal fracture. There are three types of fifth metatarsal fractures that doctors classify into three zones. Doctors classify Jones fracture as zone 2.

An avulsion fracture occurs when a tendon or ligament pulls a small fragment of bone from the main bone. This type of fracture is the result of an injury that causes the ankle to roll. Doctors classify an avulsion fracture as zone 1.

A mid-shaft fracture of the fifth metatarsal, also known as a dancer’s fracture, describes trauma or stress that usually results from trauma or twisting. Doctors classify a mid-shaft fracture as zone 3.

Anyone who suspects they have a fracture should talk with a foot and ankle specialist as soon as possible. If an injury is acute, which means it happens suddenly rather than over an extended period, seek medical care promptly.

People should also seek urgent medical attention if any of the following symptoms occur:

  • a worsening of swelling, pain, numbness, or tingling in the affected leg, ankle, or foot
  • purple skin on the leg or foot
  • fever

A medical professional can determine whether a person has a Jones fracture or another type of metatarsal fracture and can provide appropriate treatment. A Jones fracture can be troublesome and is often slow to heal. It is essential to get a correct diagnosis to ensure proper management.

To make a formal diagnosis of a Jones fracture, the doctor will:

  • ask how the injury happened or when the pain started
  • examine the foot
  • assess the location of the pain by pressing on different areas of the foot
  • take X-rays and other imaging scans

Since there is limited blood flow to the area, a Jones fracture may take longer than 8 weeks to heal. In these cases, a doctor may recommend surgery or using a bone stimulator to encourage healing. Rarely, the fracture may not heal, and the surgical screw can break. In these circumstances, a person may require additional surgery. Jones fractures also have a high rate of refracture, which is more common with nonsurgical treatment.

Complications of surgery can include:

  • problems related to surgery and anesthesia, such as blood clots
  • infections
  • the need for repeated surgery
  • refracturing after healing
  • muscle atrophy
  • continued pain and swelling

The healing time for a Jones fracture depends on the treatment method, the severity of the fracture, and the individual. A doctor may initially recommend nonsurgical options, which may take 6–8 weeks to heal. However, a person may experience pain and swelling for a few months after. If surgery is necessary, it may take a further 8 weeks to recover. It may also take up to 4 months to return to sporting activities.

Following the doctor’s recommendations and guidelines will increase the chance of a successful recovery.

Q:

Who is most likely to get a Jones fracture? If athletes, which sports do they do?

A:

Athletes, especially basketball players, tend to get Jones fractures more often than other people. This is because basketball players put their feet and bones under high levels of stress. Players often push or shove each other while in the air and often land awkwardly, with their feet striking the floor in an abnormal or uncontrolled manner.

William Morrison, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.