Jones Fracture

A Jones fracture is a specific type of break in the fifth metatarsal bone of the foot, located near the base of the small toe. Unlike other fractures in the same area, a Jones fracture occurs in a region where blood supply is limited, which complicates the healing process (1). Named after British orthopedic surgeon Sir Robert Jones, who first described it in 1902, this fracture typically results from overuse or acute trauma and is especially common among athletes and dancers. Due to its location and blood flow challenges, it requires prompt and precise medical attention for proper healing.

Symptoms

The symptoms of a Jones fracture can mimic those of a sprain or less severe foot injury, making early diagnosis difficult without imaging (2). Common symptoms include

• Pain and tenderness on the outer side of the foot, especially near the midfoot
• Swelling and bruising along the outer edge
• Difficulty walking or bearing weight
• A popping sound at the time of injury (in acute cases)
• Persistent discomfort even at rest in stress-related fractures

Unlike a simple sprain, the pain from a Jones fracture doesn’t subside quickly and may worsen with activity or over time.

Causes

Jones fractures can result from either acute trauma or chronic overuse

1. Acute injury: This occurs suddenly, such as during a misstep, fall, or twisting injury. Landing awkwardly on the foot or rolling the ankle inward can place excessive stress on the fifth metatarsal, leading to a fracture (2).
2. Repetitive stress: Athletes, particularly runners and basketball players, may develop Jones fractures due to repeated strain over time. In these cases, the fracture develops slowly and is often referred to as a stress fracture.

The location of the fracture between the base and shaft of the fifth metatarsal is an area subjected to considerable force during movement but has relatively poor blood supply, increasing the risk of injury and complications.

Risk Factors

Several factors can increase the likelihood of sustaining a Jones fracture

• Athletic activity: Sports involving jumping, cutting, or quick direction changes (e.g., basketball, soccer, tennis)
• Foot structure abnormalities: High arches or other biomechanical issues can place more stress on the outer foot
• Previous foot injuries: A history of ankle sprains or fractures may increase vulnerability
• Poor footwear: Inadequate support or worn-out shoes can increase stress on the fifth metatarsal
• Osteoporosis or low bone density: Weakened bones are more prone to fracture
• Sudden increase in physical activity: Rapid changes in training intensity without adequate conditioning

Diagnosis

Diagnosis of a Jones fracture typically begins with a physical examination, where a physician evaluates the tenderness, swelling, and deformity of the foot (3). Imaging is critical to confirm the fracture and assess its severity

• X-rays: The primary tool to visualize the fracture and determine its exact location
• MRI or bone scan: Used in cases where the fracture is not visible on X-ray but symptoms persist, or to differentiate between a Jones fracture and other types of fifth metatarsal injuries

Early and accurate diagnosis is essential to avoid delayed healing or nonunion, where the bone fails to heal properly.

Treatment Options

Treatment of a Jones fracture depends on the severity, type of fracture (acute or stress), and the patient’s activity level (2). Options include

Non-surgical treatment

• Immobilization: The foot is placed in a cast, boot, or stiff-soled shoe to keep weight off the fracture site.
• Non-weight bearing: Crutches or a scooter may be used to avoid placing pressure on the injured foot.
• Duration: Healing typically takes 6–8 weeks, but can take longer due to the limited blood supply in the fracture area.

Surgical treatment

• Recommended for athletes, displaced fractures, or non-healing fractures.
• A screw or plate is inserted to stabilize the bone and promote healing.
• Surgery shortens recovery time and reduces the risk of re-injury or nonunion.

Rehabilitation

• Physical therapy may be required to restore range of motion, strength, and flexibility after the immobilization period or post-surgery.
• Gradual return to activity is emphasized to avoid re-fracture.

 Living With or Prevention

Living with a Jones fracture involves patience and adherence to medical advice. Since healing is often slow, especially for non-surgical cases, frustration and inactivity can be a challenge (3). Strategies for managing and preventing recurrence include

• Follow-up care: Regular visits with a healthcare provider ensure proper healing and help detect complications early.
• Gradual return to activity: Athletes should follow a structured plan and avoid rushing back to full intensity.
• Supportive footwear: Wearing well-cushioned, supportive shoes reduces foot strain.
• Orthotics: Custom shoe inserts may be recommended to correct biomechanical issues.
• Cross-training: Engaging in low-impact exercises like swimming or cycling during recovery helps maintain fitness without stressing the foot.
• Bone health: Adequate intake of calcium and vitamin D, along with avoiding smoking and excessive alcohol, supports bone healing and strength.

References

1. Mein C, Jones JR, Tennick C, Williams A. Recognition of the Presence of Bone Fractures Through Physicochemical Changes in Diagenetic Bone. Appl Spectrosc. 2024 Feb;78(2):159-174. doi: 10.1177/00037028231213889. Epub 2023 Nov 13. PMID: 37960870; PMCID: PMC10832324.
2. Pham TD, Holmes SB, Coulthard P. A review on artificial intelligence for the diagnosis of fractures in facial trauma imaging. Front Artif Intell. 2024 Jan 5;6:1278529. doi: 10.3389/frai.2023.1278529. PMID: 38249794; PMCID: PMC10797131.
3. Jones B, Cohoe B, Brown K, Flores M, Peurrung K, Smith T, Shearer D, Zirkle L. Predictors of nonunion for transverse femoral shaft fractures treated with intramedullary nailing: a SIGN database study. OTA Int. 2023 Jul 25;6(3):e281. doi: 10.1097/OI9.0000000000000281. PMID: 37497387; PMCID: PMC10368386.