Decoding Jones Fracture

Jones Fracture is a break in the long bone, outside the foot (fifth metatarsal), that connects the pinkie toe to the base of the foot. Here’s how to recover

When a sudden force causes your foot to twist away from the body, there’s a possibility that you may have to deal with a Jones Fracture. It is a break in the long bone, outside the foot (fifth metatarsal), that connects the pinkie toe to the base of the foot. This type of an injury can occur from overuse, playing sports, dancing, or could be the result of a slip-and-fall accident. It usually occurs near the middle of the bone and the area can be difficult to heal. In most cases, people take a few months to recover from the fracture.

It occurs both in athletes as well as non-athletes.This is a debilitating injury for the elite athlete, particularly in cutting or pivoting sports.Jones type fifth metatarsal fracture is a common occurrence among athletes at all levels. These fractures may occur due to several mechanisms, but inversions and twisting injuries are considered some of the leading causes in sportspersons.

Jones fracture classification

• Type I (acute proximal metatarsal fracture)
• Type II (delayed union) proximal metatarsal fracture
• Type III (non-union proximal metatarsal fracture)

Causes

This type of fracture may be caused by any traumatic event or it can aslo be a result of a chronic overuse situation. When it occurs due to trauma, it is usually the result of an inversion-type sprain. In such cases, the foot is turned inward towards the other foot. There are also certain risk factors for this injury. They are as follows:

1. Taking part in activities where you sudden injuries can occur
2. Being a part of activities that involve long-term, low grade stress on the outside part of the feet
3. Participating in sports that involve a lot of pivoting movement, like basketball
4. General foot posture and having high arched feet

Symptoms

Some common symptoms of a Jones fracture are as follows:

• Pain over the middle or outside area of the foot
• Swelling
• Difficulty in walking
• Bruising or discoloration

In some cases, when the fracture hasn’t been caused by a traumatic event, the pain may develop gradually over several weeks or even months. Swelling and discoloration may not be absent in such cases

Diagnosis

During physical examination of the affected area, the medical professional may come across the following situations in case of Jones Fracture:

• Rare skin tenting from zone 1 fractures
• Tenderness to palpation along the bone at the fracture site
• Varus hindfoot alignment during weight bearing and cavus foot deformity
• Excessive lateral wear pattern on shoe treads
• Fifth metatarsal head callosity

The medical professional must also evaluate for lateral ligamentous instability and see whether the varus hindfoot is correctable. Provocative tests are required to be conducted if pain is present with resisted foot eversion.

When is surgery needed?

• If there are more than three to four millimetersof displacement or ten degrees of plantar angulation of neck or shaft fractures and closed reduction is not sufficient, operative intervention is recommended.
•  Fracture reduction and fixation should be considered if the fracture fragment involves more than 30% of the cuneometatarsal  joint.
• Mindrebo et al described nine athletes that underwent early percutaneous intramedullary screw fixation and the patients were full weight bearing within seven to ten days. They found that on average the patients were able to return to full sport by 8.5 weeks and all had radiographic union by an average of six weeks.

Points to ponder for quick recovery

1. Patients must avoid casting during recovery
2. Follow up 2 weeks post-op for suture removal and x-rays
3. Follow up 6 weeks post-op for x-rays. Transition into regular shoe wear and begin physical therapy if needed.
4. Return to sport / activity 8 to 12 weeks post-op.

The recovery phases can be divided as follows:

• Phase 1
• Rest and recovery from surgery
• Control swelling and pain
• Hip AROM: lying and standing
• Knee AROM: lying and standing
• Ankle AROM: seated only
• Sutures removed at 10 to 14 days

• Phase 2
• Progressive weight bearing in walker boot
• Massage of foot to decrease oedema(from toes to ankle)
• Control swelling with elevation
• Core and whole-body exercises and strengthening
• AROM ankle and gentle resistance band strengthening with dorsiflexion limited to first point or resistance

• Phase 3
• Full weight bearing regular shoe at 6 weeks
• AROM at ankle: PF (plantar flexion), inversion/eversion, DF (dorsiflexion) to first point of resistance
• Manual mobilization of foot as required
• Gentle mobilization of subtalar joint
• Strengthening calf / hindfoot / ankle

• Phase 4
• Proprioceptive exercises
• Single leg support
• Progress to wobble board
• Gait retraining
• Swimming
• Stepper
• Eccentric drops
• Hopping – skipping – progress to sport specific drills from 16^th week onwards

Return to play

• Athletes, who undergo screw fixation for proximal fifth metatarsal fractures, can wean out of a walking boot at 3 weeks postoperatively if pain-free with ambulation and biking.
•  The athlete could then begin stair-stepper exercises with use of a semirigid orthosis for protection. Running is allowed at 4 to 5 weeks postoperatively, if pain-free on the stair-stepper.
•  Once an athlete is pain-free while running for 30 min for 3 to 4 days per week then he or she can begin a functional progression program and ultimately return to sport.