The Jones fracture is a complex fracture of the fifth metatarsal affecting the proximal metaphyseal junction and is mainly observed in competitive athletes or soldiers. The fracture can take the form of a stress fracture or an acute fracture. Treatment is either plaster cast or surgery.
What is a Jones fracture?
When Jones fracture occurs as a stress fracture, there are few symptoms initially. However, the symptoms gradually increase over time.
According to phonecations.com, there are different fractures of the metatarsal bone. One of these is the Jones fracture. This is a near-base fracture that affects the proximal meta-diaphyseal junction in the fifth metatarsal bone and usually does not involve the tarsometatarsal joint. However, the intermetatarsal joint to the metatarsal portion of the fourth metatarsal is usually affected.
The Jones fracture has a lower prevalence than avulsion fractures of the tuberosity, which also involve the joints. There is usually a high risk of pseudarthrosis with Jones fractures if the fracture does not heal sufficiently. The Jones fracture is named after Sir Robert Jones, who suffered the fracture at a dance event in the early 20th century and subsequently described it extensively.
Different types of fracture exist. Basically, most fractures of the fifth metatarsal are referred to as Jones fractures or Pseudojones fractures, although they do not all have the manifestations relevant to this fracture.
Fractures of the fifth metatarsal are usually caused by excessive stress. If the cause corresponds to an overload, they are called a fatigue fracture or a stress fracture. Complex foot malpositions can also cause such fatigue fractures in the metatarsal area. Patients with diseases such as osteoporosis are particularly susceptible to such fractures.
A Jones fracture at the base of the fifth metatarsal usually occurs as a result of overloading the outer edge of the foot. In most cases, the fracture is preceded by outward twisting. The tendon on the short fibula muscle then often tears bony at the base and promotes a fracture at the base of the metatarsal bone.
The Jones fracture is located at the point of the metatarsus that is least supplied with blood and has little potential for self-healing due to poor blood circulation. In addition to young soldiers, athletes often have to struggle with Jones fractures, for whom the risk of twisting and overloading is part of everyday life.
Symptoms, Ailments & Signs
When Jones fracture occurs as a stress fracture, there are few symptoms initially. However, the symptoms gradually increase over time. On the other hand, if Jones’ fracture occurs as an acute fracture, the bone breaks suddenly and the symptoms appear immediately without taking a progressive form. One of the main symptoms following a Jones fracture is moderate to severe pain along the outer edge of the affected foot.
The foot usually swells and is sensitive to any touch. When straining, the pain becomes unbearable, so that severe and pain-related movement restrictions and relieving postures often occur. Jones’ fracture affects an enormously limited area of the fifth metatarsal.
Due to the narrowness of this area, there is only little blood flow, so that in most cases there are no bruises because the broken bone does not damage any vessels. If the fracture damages nerves, you may experience discomfort or numbness in the affected area. A Jones fracture requires an extremely long time to heal because of the poor blood flow. Over time, the fracture can promote nonunion.
Diagnosis & course of disease
X-ray imaging is used to diagnose a Jones fracture. The fracture crosses the metadiaphyseal junction of the metatarsal to the shaft axis and is approximately 2 cm distal to the tarsometatarsal joint. However, the X-ray clearly shows that the joint is not involved. Displaced fractures are not Jones fractures in most cases.
In young patients, the physician must differentiate Jones’ fracture from the normal apophyseal plate between the ages of 9 and 14 years. The prognosis for patients with a Jones fracture is not particularly good. In many patients, the fracture does not heal with conventional therapies, for example, or only heals with a delay, resulting in subsequent problems.
As a rule, the Jones fracture causes severe pain and also restrictions in movement. As a result, patients can also suffer from psychological problems or depression. It is not uncommon for paralysis and sensory disturbances to occur.
The patients suffer from bruising and severe limitations in everyday life. Possibly the exercise of the profession or various sporting activities is restricted or no longer possible. Jones’ fracture can be treated with a cast and by taking painkillers. Usually there are no special complications.
Life expectancy is also not restricted or reduced by the Jones fracture. If consequential damage has occurred, an operation may be necessary. Furthermore, the affected person is often dependent on regular examinations. Even after the treatment, there may be restrictions in everyday life or in movement. In some cases, the patient is then dependent on the help of other people or on a walker. Mental health problems can be treated by a psychologist.
When should you go to the doctor?
A doctor’s visit is necessary as soon as pain develops in the metatarsal area. In particular, complaints on the outer edge of the foot indicate a Jones fracture and should be examined by a doctor. If an impairment occurs after a heavy load on the foot or a fall, a doctor should be consulted.
If the foot cannot be placed on the ground without any symptoms and cannot be loaded with its own weight when moving, a doctor must be consulted to clarify the cause. If there is swelling, discoloration of the skin or a reduction in the usual stress limit, there is a health irregularity that must be examined and treated.
If the person concerned feels tightness when wearing their usual shoes or if the shoes no longer fit, a doctor should be consulted. A doctor is required in the case of restricted mobility, sensory disorders on the skin or problems with blood circulation. In some cases, the symptoms appear insidiously and there is no triggering event.
A doctor’s visit is still necessary and should take place as soon as the first symptoms are noticed. If the pain increases or spreads further down the foot, consultation is required before taking pain-relieving medication. To avoid side effects or sequelae, consultation with a doctor is strongly recommended.
Treatment & Therapy
The blood supply is critical in Jones fracture. Therefore, despite treatment options, healing is often greatly delayed. The first step in conventional therapy is plaster cast treatment of the fracture. The cast on the metatarsal bone severely restricts the patients and usually causes them many problems in everyday life. Those affected are usually given mild painkillers to relieve their pain.
The bony healing of the fracture usually takes about ten weeks. The ten-week cast immobilization is associated with severe impairment of mobility, which is hardly an option for competitive athletes, for example. If a particularly quick restoration of all mobility is required, conventional therapy is not used in most cases.
The treatment in these cases usually corresponds to osteosynthesis. Various techniques are available for this surgical connection of two or more bones or fragments. In the case of Jones fractures, for example, intramedullary screw osteosynthesis or tension strapping using a K-wire are often used. Miniplate osteosynthesis is also a suitable treatment option for Jones fracture patients.
Although the bone usually grows together faster with these surgical procedures than with conventional therapy, the therapies do not rule out subsequent complaints or areas that break open again. Regular checks are therefore often carried out long after the operation.
Outlook & Forecast
Recovery after surgery involves not only recovery from the surgery itself, but most importantly, time to allow the metatarsal fracture to heal. This usually takes 6-8 weeks, which is longer than many other fractures.
Unlike avulsion fractures, Jones fractures are prone to nonunion. Pseudarthroses are fractures that have not healed and are always diagnosed when there is no healing between two X-rays. This is usually the case after 6-8 months. Internal fixation and bone grafting may be necessary for nonunion or when fracture delay is significantly delayed.
Because the Jones fracture is in the area of the metatarsal that has the poorest blood flow, there is little chance of self-healing. If the fracture is not treated, there is a high probability that a pseudarthrosis will occur. In the most unfavorable case, incorrect healing of the fracture point must be expected. This often leads to misalignments, which can be very painful under load and require surgical correction.
Jones fracture is preventable. One of the most important preventive measures is, for example, avoiding overloading the metatarsal bones. Equally important is the avoidance of foot malpositions and the strengthening of the ligaments in the metatarsal area.
In most cases, the patient with a Jones fracture does not have any special or direct options for follow-up care. The person concerned must first and foremost see a doctor at the first symptoms and signs of the disease so that there are no further complications or other complaints. The sooner a doctor is contacted, the better the further course of this disease.
A Jones fracture does not usually reduce the life expectancy of the person affected and can also be completely healed. The main treatment is to immobilize the affected foot. The victim should rest after the accident and under no circumstances exert himself. In any case, physical or stressful activities should be avoided in order not to further worsen the symptoms.
Likewise, most Jones fracture patients rely on the help and support of family and friends in most cases, which can make everyday life easier. In some cases, physiotherapy measures are also necessary, although some exercises can also be carried out at home.
You can do that yourself
For a Jones fracture, the most important self-help measure is to rest the affected foot until the fracture has fully healed. The affected person should not exert themselves excessively for at least three to four weeks and, above all, should not put any strain on the affected foot. Sporting activities and physically demanding work must be strictly avoided. The doctor will also recommend comprehensive wound care to the patient in order to avoid inflammation and other subsequent problems.
Drug pain therapy can be supported by some natural resources. For example, ointments and teas made from willow bark, turmeric or peppermint are effective. Meditation is recommended as a supplement, preferably under the guidance of a specialist. From the field of naturopathy, for example, the remedies belladonna and arnica are recommended. Preparations with these active ingredients relieve pain and inhibit any inflammation in the area of the injury. However, taking alternative medicines should first be discussed with your doctor.
If the Jones fracture is still causing pain after a few weeks, it is advisable to see a doctor. The affected foot must be rested until healing is complete.