What is a Jones Fracture?
A Jones fracture is a fracture right at the base (long bone behind your 5th toe) of the 5th metatarsal bone. The 5th metatarsal is a fairly long bone in your foot that supports a lot of body weight, and serves as an important attachment site for several big muscles.
You may be able to feel your own 5th metatarsal base by running your fingers along the outside of your foot, because it often sticks out just a little bit around the middle of the foot.
How do I know if I have a Jones fracture?
Jones fractures are common in individuals who run, dance, or play sports. During a sports game or other physical activity you may feel a “pop” in the outside part of your foot accompanied by significant pain.
Below are some of the most common signs of a Jones fracture:
- Instant “pop” sensation
- Significant pain at the outside of the foot radiating to the bottom or middle
- Bruising of the foot (can be extensive, around the heel and under the arch)
- Numbness or tingling along the outside of the foot
- Pain putting weight on the foot
- Pain with wiggling the little toe, or moving the ankle in a circular motion
How did I get a Jones Fracture?
Jones fractures can be very frustrating because they can be caused by anything from missing a step when walking down a flight of stairs, to sports activities or vehicle accidents.
The tendon of the peroneus brevis muscle in your leg attaches to the base of your 5th metatarsal bone. When you move suddenly, or step improperly the muscle and tendon place force on the base of the 5th metatarsal, which can be so strong it breaks the bone partially or fully. This is the direct cause of the Jones fracture.
One of the most common activities known to cause the Jones fracture is a sports maneuver called “cutting”, which is a sudden change in direction with one foot firmly planted on the ground. This motion is very common in sports like football, soccer and basketball, though it can happen in any variety of low and high velocity activities.
Why is a Jones Fracture so hard to heal?
For any fracture to heal properly, there must be a steady reliable blood supply to the fractured area. The blood supply dictates how well a fracture will heal, and in the case of the Jones fracture, poor blood supply can cause significant difficulties. The Jones fracture occurs in an area of the 5th metatarsal bone where there is very minimal blood flow, making it prone to healing slowly, or not at all.
The Jones fracture tends to be difficult to heal. This fracture requires a longer time non-weight bearing and in a cast. They also have a higher chance of needing surgery.
Who should have surgery on Jones fractures?
Surgery is only recommended for Jones fractures that have not healed with conservative treatment or whose livelihood depends on a swift recovery. About half of all Jones fractures can be treated without surgery, and we will try everything possible to avoid surgery.
How do you choose what Jones fracture surgery to use?
There are many different approaches to a Jones fracture surgery, and each surgeon chooses to perform a version that is appropriate for the fracture, and they are comfortable with. If you speak to several different doctors, each doctor may give you a different plan for fixing your Jones fracture.
At the Foot and Ankle Center of Washington we have tried multiple approaches, and we have been around long enough to see many approaches wax and wane in popularity among surgeons. The technique we use now is practiced by many surgeons in the United States, and is based on evidence from the most up to date medical literature. We use this approach because it produces the best chance for healing and in our experience it has the fewest complications out of any procedure we’ve tried, even for tough Jones fractures.
What happens during the Jones fracture surgery?
The Jones fracture surgery will begin as any foot surgery does, you can read about this on our detailed Pre Surgical Preparation page. You may be placed on your side for the duration of the operation, to give your surgeon a better view of your fracture site on the outside of your foot.
Below are the steps that follow while you are under anesthesia:
- An incision is made over the top of the 5th metatarsal bone on the outside of your foot, the incision may be anywhere from 3-5cm long to view the fracture.
- The fracture is identified and soft tissue stuck in the fracture is cleaned out.
- In order to promote healing, a small bone graft is taken from your heel bone though a 1-3cm incision on the outside of your heel. The bone graft is shaped like a pencil eraser, only slightly larger.
- Taking a bone graft from your heel bone has very minimal side effects, and the benefit of healing your Jones fracture is immense. Once the graft is taken, the incision will be closed with several stitches. The heel bone heals quickly.
- The Jones fracture will be prepared for placement of the heel bone graft by removing a similarly shaped piece of bone from the center of the fracture in the 5th metatarsal bone. The heel bone graft will act like a bridge of healthy bone to unite the two sides of the fracture.
- Once the heel bone graft is placed into the Jones fracture site, a metal plate with several screws will be used to secure the two sides of the Jones fracture together with the graft comfortably seated in the middle.
- The size of the plate and the number of screws depends on how big your foot is, and what the fracture looks like.
- Be sure to tell your surgeon about any metal allergies you have before your surgery, this is important because of the metal plate that’s placed in your foot.
- Once the graft, plate, and screws are in place, the incision is sewn closed and a bandage is placed over the site. A plaster splint will be made around your foot which provides soft support and prevents movement of the ankle. This is to prevent the peroneus brevis muscle from firing and pulling at the base of the 5th metatarsal bone.
When can I walk, run or drive after a Jones fracture surgery?
After your surgery you will want to take a few days to rest and stay off your feet. You will want to ice, elevate (a couple of pillows) and protect the foot that had surgery. You will probably want to take it easy for 1-2 weeks.
You will put absolutely no weight on your foot for 4 weeks, this is crucial because the Jones fracture site is so delicate, and even minor motion across the graft can cause failure. You will need a knee scooter or crutches to help you walk.
At the 4 week mark you will begin to transition to placing more weight on your foot. You will be wearing a surgical boot to protect the foot, and the transition from non-weight bearing to full weight bearing could take 2 weeks to 4 weeks. By the 6-8 week mark you should be able to walk on the surgical foot, though the length of recovery varies significantly by person.
At the 8 week mark, if healing has gone according to plan, you may begin slowly returning to activity starting with physical therapy. Most individuals are able to return to full sports activity at between 4 and 6 months after their surgery, however it may take up to a year to fully recover.
Some helpful tips for shortening your recovery:
- Follow doctor’s postoperative orders, no weight bearing until week 4.
- Keep the foot elevated for the majority of the day to allow swelling to decrease.
- Wear the post operative surgical shoe/boot until you have returned to full weight bearing.
- Zero tobacco products, or nicotine in your system for the duration of your recovery.
- Eat a healthy well balanced diet.
- Rest while you are recovering, have a full night’s sleep every night.
- Protect the surgical foot as much as possible until you are fully recovered.
- Attend physical therapy if your doctor recommends it.
I Need a Jones Fracture Surgery, What Do I Do Now?
First and foremost establish a relationship with a foot and ankle surgeon whom you trust. Discuss your treatment options with your surgeon and devise a surgical plan that works best for you.
View our Pre Surgical Preparations page to get a more complete view of everything required for surgery, and how to prepare.
If you are in the Seattle area, please make an appointment at our convenient Seattle Clinic. We can work with you to treat your Jones fracture and get you back on your feet. Our talented foot and ankle specialists Dr.Huppin and Dr.Hale have many years of experience with conservative treatment, focusing on avoiding surgery and rehabilitating your Jones fracture.
If conservative treatment fails, our podiatric surgeon Dr.Hale has many years of experience in the sports medicine foot and ankle surgery field and can help you navigate your Jones fracture surgery.