5th Metatarsal Fractures:
Jones and Pseudo-Jones
What is the 5th metatarsal and how do fractures occur?
The 5th metatarsal is a bone of the foot directly below the pinkie toe and is one of the most common foot fractures that we see. Fractures to the 5th metatarsal commonly result from trauma, usually a very forceful roll of the ankle. These fractures are also commonly seen in ballet dancers given the repetitive stress placed on the 5th metatarsal during dancing.
Pseudo-Jones (Dancer’s) Fracture and Jones Fracture:
The location of the fracture along the 5th metatarsal is extremely important given the varying blood supply along the 5th metatarsal. We will only discuss two zones for the purpose of this section. Zone 1 fractures are called Pseudo-Jones (Dancer’s) Fractures. Blood supply to Zone 1 tends to be good, so non-unions (i.e. fractures that don’t heal) are relatively uncommon. Fractures within Zone 2 are called Jones Fractures. Blood supply to Zone 2 tends to be poor, so non-unions are more common and tend to occur at a rate of 15-30%.
Patient’s most commonly present with pain, swelling, and bruising over the outside border of the foot, especially with weight bearing or inversion of the foot.'
An x-ray is usually ordered to evaluate for fracture and other bony pathology. A CT scan may be ordered to further evaluate cases of delayed healing and non-union, while an MRI may be ordered to rule out other pathology.
Nonoperative treatment is the mainstay of treatment and depends on whether the patient has a Pseudo-Jones or Jones Fracture. Patients with Pseudo-Jones and nondisplaced Jones Fractures are both usually placed into a walking boot, yet Jones Fracture patients must remain non-weightbearing with crutches given their increased likelihood of non-union. Patients with Pseudo-Jones fractures may continue to weight bear as tolerated so long as they remain in the walking boot when weight bearing. It is important to note that symptoms may persist for up to 6 months following evidence of radiographic healing and return to work/sports.
Surgery is usually reserved for displaced Jones fractures or patients who fail nonoperative management. These patients typically experience ongoing pain in the setting of poor healing on x-ray despite prolonged periods of immobilization. Surgery can also be recommended as a first-line treatment in elite or competitive athletes in order to safely expedite return to play. The same argument can be applied to anyone else who wishes to return to activities as soon as possible. Surgery most commonly involves placing a small screw down the center of the 5th metacarpal bone to apply compression across the fracture site and realign the bone.
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Following surgery, for either Jones or Pseudojones fractures, immediate weight bearing in a walking boot is allowed, but the first two weeks will typically be done gingerly. At about the 3-4 week mark, the walking boot can be switched over to a stiff soled shoe, while physical therapy is begun. If necessary, the earliest return to sports would be in the 6-8 week range, depending on how well the bone looks on xray, and how well the patient is progressing with physical therapy.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.