Jones fracture was named after Dr Robert Jones, an orthopaedic surgeon who sustained the injury while dancing in the early 1900’s. A lot has changed in rehabilitation medicine since then. We can help you with your 5th metatarsal fracture recovery so that your Jones fracture heals without complications. Jones fracture treatment with physiotherapy aids recovery, speediest isn’t always best in the long run, or dance marathon in this case.
The Anatomy of your 5th metatarsal
Your foot is an amazingly complex mechanical design. It has 28 bones that articulate with one another to form 33 joints on each side! 19 different muscles attach and form 100 cross bridges with ligaments in your foot. Many tiny peripheral nerves send information down to allow muscle contraction to propel you forward while walking or maintain your balance when landing from a jump. These nerve endings also receive information from the surface you are navigating, the pressure of those new shoes on your heel and the temperature when you wet your toes in icy water.
Anatomists divide the foot into the hind, middle and forefoot. Your forefoot has 21 bones. There are the 5 metatarsal bones, that connect the midfoot (arch) with your toes. You also have 14 phalanges, the tiny bones in your toes, two in the big toe and three in your other four toes.
Your 5 metatarsals are counted and named from the inside to the outside. So your 1st metatarsal connects to your big toe and your 5th metatarsal to your pinkie toe. Metatarsals have distinct areas. The base of the metatarsal connects to the tarsal bones, the shaft is the middle, slender part of the metatarsal bone and the head articulates with your proximal phalanges to the toes.
Jones fracture happens when the base of the 5th metatarsal is broken. A smaller part at the tip of the head of the 5th metatarsal is an avulsion fracture, while a break through the shaft of the metatarsal is usually caused by overuse and a stress fracture.
What exactly do my metatarsals do?
Your 5 metatarsal bones provide structural stability for the 3 arches of your foot. Your foot arches absorb and transfer forces during walking. This acts as a leverage system during the push-off phase of your gait cycle for the back leg and support from the ground up when standing still. The metatarsals also provide insertion sites for all the different muscles of your foot.
How did my Jones fracture happen?
Bone is elastic to a certain degree, which means that the tissue allows for some shape change, but much less than a ligament or muscle. A growing child’s bones would be more elastic than an adult’s. When the load applied exceeds the elastic capacity, tissue failure occurs. The angle, movement direction and force determine if you end up with a Jones fracture.
Different types of forces come into play in a weight-bearing, walking foot. Your metatarsals are most susceptible to shear forces, as in wringing out a dishcloth. When you are running fast and suddenly have to change direction, when shear force exceeds the bone tissue’s ability to deform, you end up with a fracture. A Jones fracture describes a fracture of the base of the 5th metatarsal’s zone 2.
Causes of Jones fracture
- Direct trauma
- Falling over your ankle
- Landing on the outside of your foot
- Kick
- Fall onto/fall of other player onto you
- Quick, sudden direction change
- Overuse in specific sporting disciplines
Athletes that at more at risk of a Jones fracture:
- athletics
- long-distance runners
- trail runners
- basketball players
- soccer players
- dancers
- tennis players
Nonunion occurs with up to 37% of Jones fractures
How severe is my Jones fracture?
A Jones fracture is sore. It is a frustrating injury to have when you need to navigate your world with crutches. We aim to facilitate the physiological healing process and avoid complications. Complications from a fracture can be as simple as stiffness of the joint or as severe as a blood clot or complex regional pain syndrome. Jones fractures are notorious for complications of malunion or nonunion.
Comorbidities like being a smoker, having diabetes or cardiovascular conditions influence circulation and therefore healing speed. If you have had previous foot injuries or complicated surgeries you are at risk of developing complex regional pain syndrome. Complete bed rest and oral contraceptives can increase your risk of developing blood clots.
Your 5th metatarsal fracture and your circumstances are unique. Our physiotherapists can screen and advise you so that we can customise your care.
Pain that worsens should be evaluated
Diagnosis of Jones fracture
Physiotherapy diagnosis
Our physiotherapists can make a clinical diagnosis of a 5th metatarsal fracture in the rooms. To determine the exact location, which is necessary to distinguish between an avulsion and Jones fracture, you will need X-rays. We understand the physiological healing stages bone goes through. The rest of you don’t have to sit around and wait for your metatarsal to heal, we can give you alternative movement and exercise ideas that you can pursue throughout your recovery. By understanding your recovery you will be able to make responsible decisions. This enables you to avoid compensatory pathologies, like developing sciatica because you were limping too long.
X-rays
X-rays show the integrity and alignment of your foot bones. We can see the exact location of a metatarsal fracture on a basic dorsal plantar and lateral view X-ray image. This location is important to accurately distinguish between an avulsion and a Jones fracture. Your physiotherapist can refer you to get X-rays taken if necessary.
MRI
An MRI scan can visualise all of the structures in your foot, including muscles, tendons and ligaments. This is an expensive image for an isolated 5th metatarsal fracture but may be needed in a complicated scenario with multiple injuries to determine the extent and guide treatment. If your physiotherapist suspects anything more than just a metatarsal fracture, you will be referred to the right specialist to have the necessary imaging done.
Why is the pain not going away?
A Jones fracture that is not immobilised and rested will not heal. Squeezing and forcing your foot into running shoes, training through the pain and ignoring your symptoms will not make the pain go away.
If you are wrongly diagnosed you are not getting the correct treatment and this may cause delayed or non-union of your 5th metatarsal fracture. You may become stuck in a cycle of pain. Not knowing what you should do and avoiding all movement is not the answer either. This can lead to restrictions, muscle weakness and later even knee, hip or back pain.
You need the correct intervention at the right phase of your recovery. This ensures the best outcome with the lowest risk of complications.
Problems we see when patients come to us with Jones fracture foot
Waiting too long
The longer you wait, the bigger your chances of compensation strategies causing other pathology. Yes, limping after your Jones fracture is normal, but do that for 3 months and you are guaranteed hip or back pain because of the way you move.
Starting strenuous activities too fast
Your 5th metatarsal fracture may feel better with daily walking or driving after 8 weeks, but hold on before you lace up those tekkies and try to catch up on lost steps. If you haven’t put in the work to restore your ankle range of motion you can end up with other injuries, like plantar fasciitis. Our goal is to keep you as active as possible, but safely so for the phase of healing that you are in.
Crutches
Crutches are only needed during the first 2 weeks or if you have long distances to walk at work. The crutches take the load off of your Jones fracture. When your pain settles you will be able to walk with only the brace or strapping. This ensures your knee, hip and back moving as normally as possible.
Misconceptions about treatment
The healing of bone is sore. Pain doesn’t mean more damage. We can look at other signs like swelling, temperature and movement during your recovery as your body does an amazing job of healing bone.
Physiotherapy treatment for Jones fracture
Our physiotherapists can distinguish between bone, including joint, ligament, tendon, muscle and nerve injuries. We understand how these structures have to work in harmony to ensure fluid, balanced and precise movement. Movement patterns and how joints influence one another are a language we understand like musicians understand notes and dancers’ choreography. We can provide the best treatment for your Jones fracture. Our physiotherapists provide guidance and answers to your questions, while we implement an effective and structured plan of action for your 5th metatarsal fracture recovery.
Phases of Jones fracture rehabilitation
1st Phase of Jones fracture treatment: Protect and relative rest (weeks 0 – 2)
Once the correct diagnosis is made we can explain your recovery journey and goals. Your physio will teach you the basics of protecting your metatarsal fracture, what to do and what other movements or alternate exercises you can do. We can aid pain relief with some electrotherapy modalities.
2nd Phase of Jones fracture treatment: Active range of motion (weeks 3 – 4)
Now that your pain has settled we can incorporate active ankle, foot and toe movements into your exercises. You should be able to separate your toes and move them up and down through full range to progress to the next phase of your metatarsal fracture rehabilitation.
3rd Phase of Jones fracture treatment: Resisted training (weeks 5 – 6)
Now the fun starts when we can add resistance to your gained movement. Balance drills and therabands will be part of your routine now. Once you can do a set of 15 calf raises you can progress to the next phase of your metatarsal fracture treatment.
4th Phase of Jones fracture treatment: Gait & conditioning (weeks 7 – 8)
During this phase of your fractured metatarsal recovery, you can expect the focus to fall on precision and push-offs during the gait cycle, some lunges and explosive exercises like skipping.
5th Phase of Jones fracture treatment: Return to activity (weeks 8 – 12)
We incorporate your unique needs in your final rehabilitation to ensure you’re safe to turn to jogging or other exercises requiring stability and agility. Burpees, sun salutations or pointe, we will help you get back to what you love doing.
You should be able to do repeated single leg hops to get the go-ahead for your first jog.
Healing time for 5th metatarsal fracture
Bone fractures take 6-8 weeks to heal. Getting back to wearing high heels or running may take another 4 weeks where you are actively working on gaining strength, endurance and mobility.
We aim to explain the recovery and goals during your first consultation and give you pain relief strategies. The real work starts between 4 – 8 weeks when we can assist you with rehabilitation exercises to enable you to return to your hobbies, exercise and everyday life. Between weeks 4 – 8 weeks of your Jones fracture recovery, we will see you every week to progress your rehabilitation exercises. From week 8 and onwards your treatments will be every second week to adjust your walking or slow run program.
Other forms of medical Jones fracture treatment
- Your doctor (GP) will most probably prescribe oral analgesic medication to aid in pain relief.
- An orthotist can provide the moon boot if your Jones fracture doesn’t need to be cast in plaster of Paris.
- A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport, that is after you can move your toe and ankle through full range of motion.
Is surgery an option for my Jones fracture?
Surgery is necessary for displaced Jones fractures, which means that the bone fragments have moved away from one another. Surgical fixation brings the bone ends closer together to “close the gap” and encourage union. Surgical internal fixation connects the bone ends with pins, wires or screws.
You will be immobilised in a cast for a few weeks, depending on your surgeon’s protocol. You can also expect some time in a moon boot. Some rehabilitation can already begin at this stage, but the hard work starts once the cast and boot period is over. Now you must regain motion, strength, proprioception and balance to return to your everyday living.
Going through a costly surgery, but neglecting your rehabilitation, is a waste of time and money. After a period of immobilisation, you have to reintegrate movement and strength exercises to ensure equal weight bear. Compensation strategies can lead to problems and pathology elsewhere, later in life.
What else could my 5th metatarsal pain be?
- Avulsion fracture of 5th metatarsal
An avulsion fracture happens closer to the base of your 5th metatarsal, the diagnosis will be location specific and determined with X-rays. Your symptoms will be similar to a Jones fracture.
Pain that gets better with movement and worsens with rest is caused by inflammation of a tendon. No damage to the bone will be visible on X-rays.
Falling or turning over your ankle can cause a ligament sprain or rupture. This may happen in isolation or with your Jones fracture.
- Fibular nerve entrapment
Pins, needles and numbness over the outside of your foot is indicative of fibular nerve entrapment.
Jones fracture is also known as:
- 5th metatarsal fracture
- Jones foot fracture
- metatarsal stress fracture
