5th Metatarsal Fracture: Jones Fracture

Understanding the Jones fracture

What is a Jones fracture?

The Jones fracture is one of the fractures of the fifth metatarsal, the bone located at the base of the little toe. This fracture is often considered more serious than other fifth metatarsal fractures, as its treatment may potentially require surgery. It frequently occurs following excessive effort or a change in training routine, making it much more common among athletes.

The fifth metatarsal is divided into three zones: the diaphyseal portion, which is the long part of the bone, with the ends being the epiphyseal areas rich in spongy bone. The transition area between the diaphysis and the epiphysis is called the metaphysis.

The Jones fracture refers to a fracture at the proximal end of the fifth metatarsal, at the junction between the metaphysis and diaphysis. This area is a weakness point of the fifth metatarsal due to its poor arterial blood supply. Any uncontrolled increase in physical activity or a non-gradual increase in training intensity will cause significant overload in this transition zone. For the bone to become stronger at this site, it will undergo local resorption to permit reconstruction. The breakdown of bone tissue stimulates its rebuilding and reinforcement. During this resorption period the bone is relatively more fragile, and if training mistakes are not corrected, the risk of fracture is very high. In addition to the intensity and frequency of training, incorrect footwear can cause stiffening beneath this weak area of the fifth metatarsal and potentially lead to a Jones fracture. Finally, the Jones fracture can be favored by anatomical factors that increase localized pressure, particularly in the case of high arches or varus deformity of the ankle and hindfoot.

This fracture is frequently a bone insufficiency or stress fracture, especially seen in athletic patients who practice football and basketball. It is not uncommon to observe significant bone remodeling of the fifth metatarsal related to repeated fractures in this area.

Causes and symptoms of Jones fracture

The causes of a Jones fracture of the 5th metatarsal can be varied, but here are the most common ones:

• Direct trauma: such as falls or blows to the foot.
• Overuse: intense sports activities, especially those that require sudden changes in direction.
• Biomechanical factors: high-arched feet or other varus deformities of the ankle or hindfoot, which put more pressure on the 5th metatarsal.
• Sports practices: sports with pivoting and contact such as football or basketball are frequent causes of 5th metatarsal fractures, especially Jones fractures.

The symptoms you may experience include:

• Pain of varying intensity, which may be sharp, on the outer edge of the foot.
• Swelling and bruising in the affected area.
• Difficulty walking or putting weight on the foot.
• A feeling of instability in the injured area.

Identifying these signs quickly can help you avoid complications and get the treatment you need.

Diagnosis and treatment

Diagnostic Methods for a Jones Fracture

To diagnose a Jones fracture, several examinations can be performed to confirm this specific lesion at the level of the fifth metatarsal. Here are the most commonly used methods :

• X-rays : This is generally the first test offered to visualize fractures. They allow the detection of bone anomalies and confirm the presence of a fracture of the 5th metatarsal. It is necessary to perform a weight-bearing X-ray assessment of both feet. A thickening of the bone structure of the 5th metatarsal may correspond to a Jones fracture.
• MRI (Magnetic Resonance Imaging) : If X-rays do not reveal the fracture, an MRI can visualize the fracture at an early stage, especially when it is a stress fracture, insufficiency fracture, or stress-induced fracture.
• CT scan : The CT scan is the best exam for analyzing the bone structure, especially in the case of 5th metatarsal fractures of the Jones fracture type. It allows visualization of the cortical thickening and filling of the medullary canal, especially in cases of repeated trauma and re-fracture of the fifth metatarsal.
• Bone scintigraphy : Although rarely necessary, this method can detect fractures not visible on X-rays, particularly in cases of stress fractures. Bone scintigraphy is advantageously replaced by MRI.

It is recommended to consult an orthopedic specialist to obtain a precise diagnosis with appropriate treatment and follow-up.

Treatment Options for a Jones Fracture

Treatment for a Jones fracture depends mainly on the type of sports activity, the athletic level, and the bone remodeling visible on X-ray and CT scan, which may indicate successive fractures or pseudarthrosis (failure of bone consolidation). As with any fracture, treatment of this fifth metatarsal fracture can be orthopedic or surgical.

Non-surgical treatment :

• Immobilization of the foot using a splint or cast to promote healing.
• Rest and elevation of the affected limb to reduce swelling and pain.
• Taking painkillers to relieve pain.

Surgical treatment :

If the fracture is complex or if non-surgical treatments do not provide the expected results, surgery may be considered. Surgical stabilization of the fracture can be achieved with screws or a plate with screws.

After treatment, a rehabilitation program is often recommended to help restore foot function. This program includes strengthening and stretching exercises, which promote optimal recovery and help prevent future injuries. Regular follow-up with a healthcare professional is important to ensure optimal recovery.

Our approach to Jones fracture

The Jones fracture is ultimately a bone insufficiency fracture in high-level athletes who subject the outer edge of the foot to very high pressures. The morphology of the ankle, hindfoot, and foot is generally a factor that anatomically increases pressures on the fifth metatarsal.

Poor footwear choices, or simply changes when switching to a different brand of football boots, for example, are factors to consider in the stresses experienced by the fifth metatarsal.

Excessive and sudden increases in the intensity and pace of training trigger biological bone reactions that allow the bone to increase its strength. The subsequent phase of bone remodeling is a period of relative fragility for the fifth metatarsal.

Once the diagnosis of a Jones fracture is established, it is essential to analyze the bone structure on the X-ray, which makes it possible to determine whether the fracture is recent or if there is a bone healing defect called pseudarthrosis. Repeated fractures of the fifth metatarsal also show significant bone remodeling. In such cases, the bone structure is altered and the risk of a bone healing defect increases.

It is widely accepted that a recent Jones fracture can be treated orthopedically, with adequate plaster immobilization and no weight-bearing for a period of one to one and a half months. Follow-up is then both clinical and radiological; resumption of sports activities may occur once bone healing is confirmed. However, the healing time varies depending on the individual, the sport and level practiced, and the morphology of the lower limb. The risk of recurrent fracture of the fifth metatarsal at the same site increases in the absence of surgical stabilization.

However, in high-level athletes, treatment is usually surgical, as it allows initial stabilization of the fracture, reduces the bone healing time, and considerably limits the risk of recurrent fracture.

In the event of a recurrent fracture or lack of healing of a Jones fracture, treatment then becomes surgical.

Prevention and rehabilitation

Tips for Preventing Jones Fracture

Preventing a Jones fracture is a proactive approach, especially for athletes or those who lead an active lifestyle. Here are some practical tips to keep in mind:

• Choose suitable shoes: Opt for shoes that offer good support and cushioning. Your pair of shoes should be appropriate for the physical activity practiced, and it's necessary to change them regularly to maintain good support and cushioning.
• Strengthen the foot muscles: Incorporate exercises to strengthen your feet.
• Stretch the posterior muscle chains: Stretching the calf muscles, known as the gastrocnemius, as well as the hamstrings, is very important to reduce pressure in the ankle and foot joints.
• Prefer flat surfaces: When walking or running, choose flat and well-maintained terrain to reduce the risk of twists and falls.
• Vary your training: Repeating a movement or physical exercise increases local pressure on the foot and ankle. By varying your training route, the training surface, and the order of exercises, pressure is distributed more heterogeneously at the ankle and foot, which is protective.
• Listen to your body: Pay attention to signs of fatigue or pain in your feet. Give yourself enough rest time to avoid injuries.

Importance of Rehabilitation

Rehabilitation after a Jones fracture is crucial to regain optimal foot function. A well-thought-out rehabilitation program can make all the difference:

• Speed up recovery: Regular follow-up with a physiotherapist allows the exercises to be adapted to your specific needs, which promotes recovery.
• Restore strength, mobility, and stability: Targeted exercises strengthen the muscles in your feet and improve your mobility, helping reduce the risk of further injuries.
• Soothe pain and inflammation: Techniques such as cryotherapy and pressure therapy can be incorporated to relieve pain and support healing.
• Inform the patient: Rehabilitation is not just about doing exercises; it also includes advice on good practices to avoid future injuries.

Thus, effective prevention and appropriate rehabilitation help you recover after a Jones fracture and minimize the risk of another injury.