That sharp shooting pain on the outside of your foot that occurs after twisting your ankle or landing awkwardly can bring your activity to a halt—literally. For many individuals, that pain is caused by a Jones fracture in the foot, a particular kind of break that can be worse than it seems. This article covers what exactly a Jones fracture is, how it is distinct from other breaks, what causes it, and what you can do about it.
It is important to learn the details because the Jones fracture has a reputation as a “bad” break because it heals slowly and can recur if not treated properly. Whether you are an athlete, a weekend warrior, or just stepped off a curb wrong, we will walk you through everything you need to know.
What Is a Jones Fracture in the Foot?
A Jones fracture in the foot is a fracture of a very particular point on the 5th metatarsal— the long bone that runs along the outside of your foot towards your pinkie toe. This isn’t just any fracture in the 5th metatarsal. It’s the precise location of the fracture that makes it a Jones fracture, and the spot is perhaps the toughest place to treat successfully.
Anatomy of the Fifth Metatarsal and Fracture Location
The 5th metatarsal can be divided into three zones along the length of the bone; at the base, Zone 1; a small transition zone, Zone 2; and a larger transition zone in the shaft, Zone 3. A Jones fracture is defined as a fracture at the metaphyseal-diaphyseal junction, the transition between Zones 2 and 3. The blood supply here is less extensive than in other parts of the foot and therefore the healing process is slower and there is an increased likelihood of non-union.
Jones Fracture vs Other Fifth Metatarsal Fractures
Numerous references (and even a few G.P’s.) seem to confuse the classic “Jones” with the avulsion injury. The avulsion occurs at Zone 1, at the extreme tip of the base, when a sprain causes the attachment of a tendon or ligament to pull off a small piece of bone in extreme inversion of the ankle. That one, although painful, will heal, with conservative management, much more quickly and predictably than a true stress fracture.
A stress fracture is characterized by a two stage process of expansion with load, in the absence of trauma. Classification is in fact critical, as it guides management (Kelly & Lee, 2001).
Common Causes and Risk Factors for Jones Fracture in the Foot
Most Jones fractures occur as a result of a mechanical event. That is, most breaks will occur either in response to a specific event or will develop chronically due to overuse. Identifying the cause can help you better identify potential risks in yourself.
Acute Injury Mechanisms (Sports and Daily Activities)
The classic example is a sudden inversion of the ankle, with the foot turning in sharply while the weight is directed through the lateral aspect of the foot. This pattern is common in basketball players, football players and dancers as their sports require quick changes of direction and high impact jumps. However this can happen in an un sporting situation, stepping off a curb awkwardly, falling on uneven ground, or badly landing after a simple jump can produce forces great enough to snap the bone in the vulnerable area.
The fracture can occur in an instant and the pain is usually sharp.
Overuse, Stress Fractures, and High-Risk Groups
However not every Jones fracture occurs as an acute event. Some are under-appreciated, slowly occurring stress fractures which regularly occur in people who undertake high volumes of mechanical stress such as marathon runners, military recruits and dancers doing high volumes of training with insufficient recovery. Anatomical factors such as a high arch foot (cavus foot) exert increased medial forces on weight bearing in the foot.
Factors such as poor shoes, training on hard surfaces and progression of increases in training load are contributing factors. Underlying loss of bone mass or poor nutritional status with low vit D and calcium intake may predispose certain individuals to stress related fractures.
Signs, Symptoms, and When to See a Doctor
Early diagnosis of a Jones fracture can really help in the speed of recovery. The signs are quite specific, but they can be mistaken for a sprain, which is another reason it can be missed.
Typical Symptoms and How They Feel
The most constant symptom is pain at the lateral border of the foot, in particular around the base of the fifth metatarsal. Swelling appears relatively quickly (within the first hour) and there is often bruising of varying extent extending across the dorsum of the foot, or even into the toes. Weight bearing is uncomfortable to impossible, depending on the severity of the injury.
During the first 24-48 hours the pain can be constant at rest when the foot is dependent.
Warning Signs of Complications
Some indications of a more severe injury or that complications are occurring are if there is a visible deformity along the lateral border of the foot, if there is severe and increasing swelling after 24-48 hours of resting and elevating the limb or if they can’t tolerate any weight on the foot after 48hours. If the pain does not resolve after a few weeks of conservative management then this may indicate a non-union and the fracture site should be reviewed.
Diagnosis and Treatment Options for Jones Fracture in the Foot
Having the correct diagnosis is the starting point to treatment. This is not an injury to be self-managed on the basis of an educated guess, as this will only prolong the problem.
How Jones Fracture in the Foot Is Diagnosed
A physical exam is performed first by a doctor by palpating along the fifth metatarsal to find the point of point of maximum tenderness. Plain X-rays will determine the fracture by location, usually in the zones. An MRI or CT scan may be ordered sometimes especially if a stress fracture is suspected to determine the state of the bones and early signs of non-union.
Non-Surgical vs Surgical Treatment Approaches
Conservative treatment usually means immobilization in a non-weight-bearing cast or walking boot for six to eight weeks, supported by crutches to off-load the foot. This can be effective but has longer healing times in some cases. Surgical fixation, most commonly with an intramedullary screw through the length of the bone, is favored in competitive athletes, in those with delayed healing of the fracture and in those with a previous Jones fracture in the same foot.
This has a faster, more predictable return to activity.
Recovery, Rehabilitation, and Long-Term Outlook
A Jones fracture can be healed, but you have to have patience. Returning to activity too early is one of the most frequent causes of re-occurrence.
Typical Healing Time and Rehab Milestones
Generally non-operative healing time takes from 8-12 weeks, although there are a few where healing time can take longer. When the radiographs show the bone has healed, then this is followed by gradually increasing the weight bearing. Initially this is partial weight bearing, and then finally into weight bearing.
There is then physiotherapy to get the ankle and foot strength, flexibility and balance back. It is then often up to 3-6 months before return to sport or high impact activity depending on method of treatment and healing response.
Preventing Future Foot Injuries and Jones Fracture Recurrence
Use of an appropriate supportive footwear for your specific foot type is perhaps the most effective protective measure in a day-to-day life. Consistently replacing shoes before excessive wear occurs and preventing sudden increases in running mileage are also highly recommended. Strengthening the muscles around the ankle and foot, especially the peroneals, will offer more dynamic support to the lateral side of the foot.
Having experienced a Jones fracture previously, a podiatrist may suggest the use of a podiatrist prescribed orthotic that would shift the pressure off the lateral side of the foot while running.