A Jones fracture is a fracture of zone 2 of the fifth metatarsal (little toe). The fifth metatarsal bone joins the smallest toe to the rest of the foot and has three zones along its length, starting from the base near the middle of the foot and extending out toward the toes. Each zone can provide specific details to the healthcare provider about exactly where there is a break. Zone one is the head of the fifth metatarsal, and Zone two is the body extending out from it, further away from the middle of the foot.
This article will provide more information on Jones's fracture by discussing causes, signs and symptoms, management and treatment, and diagnosis.
A Jones fracture refers to a break in Zone 2 in the fifth metatarsal, the bone that joins the pinkie toe to the rest of the foot. This fracture can happen when a person increases their training, increases pressure on their feet from gaining weight, or runs on uneven surfaces. Jones fractures are one the most common foot fractures.1 Athletes, dancers, and people whose jobs require them to be constantly on their feet are particularly susceptible to them.1
Causes of a jones fracture
Jones fractures are caused by a sudden impact to the foot while it is twisted, usually with the heel lifted.1 Some of the most common causes include:
- Chronic overuse: excessive walking, running or standing on hard surfaces for too long
- Injuries: jumping like in football, basketball, gymnastics, dancing or making a sudden twisting motion
- Accidental falls and slips: tripping on the stairs or catching yourself suddenly after slipping on a wet floor
Signs and symptoms of a jones fracture
As with other types of fractures, Jones fractures have many of the same symptoms. The fracture can present itself as the onset of pain on the outside of the midfoot, often without a sudden injury. On the other hand, some people may not experience pain, even with weight bearing. However, a person with a Jones fracture may know they have injured their foot right away if the injury is sudden and causes immediate symptoms.2 These symptoms include:
- Localised pain, swelling, and tenderness on the outside of the foot at the base of the little toe
- Difficulty walking or weight-bearing
- Bruising (ecchymosis)
Management and treatment of a jones fracture
In non-athletes, a cast or boot is placed over the injured foot. Initial home treatment advice may also include the following:
- A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short-term pain relief from the discomfort. This needs to be applied to the bruised area for up to 15 minutes every few hours while ensuring that the ice is never in direct contact with the skin.
- The foot should be rested for the first 24 to 72 hours so that the early stages of healing can begin. If lying in bed or sitting on a chair, the ankle should be raised above the level of your hips to reduce swelling.
You might also be advised to do some exercises for your ankles and feet to help with healing and range of motion:
- Movement of the ankle and foot is important, especially in the early stages of the healing, to promote circulation and reduce the risk of developing a deep vein thrombosis (DVT). This can ensure the ankle and foot do not become stiff
- Early weight bearing (putting weight through your injured foot) can help increase the speed of healing. Walking as normally as possible will also help the recovery process
The above recommendations show healing between 50-76% of the general population.3,5 When treating competitive athletes, operative treatment is likely the most effective treatment option, with a 96% success rate.3 To maximise healing, nutritional and hormonal deficiencies need to be identified and corrected.3 This is recommended in those with a history of fractures and slow or no healing.3
A Jones fracture can be troublesome and is often slow to heal. To ensure proper management, it is crucial to get a correct diagnosis. The appropriate treatment for Jones fractures or other metatarsal fractures can be determined by a medical professional. Patients with Jones fractures have point tenderness and swelling over the fifth metatarsal base of the little toe).3,4
The doctor will use the following to make a formal Jones fracture diagnosis:
- Ask how the injury happened or when the pain started
- Examine the foot
- Assess the location of the pain by pressing on different areas of the foot
- Take X-rays and other imaging scans to identify the impacted zone (I, II, or III) in the metatarsal bone
How can I prevent a jones fracture?
The risk of a Jones fracture can be reduced by maintaining a healthy weight and managing diabetes. People with diabetes and obesity are at higher risk of complications associated with metatarsal fractures. Smoking extends the healing time of fractures, according to medical evidence; in extreme cases, it can stop healing altogether. Stopping smoking during the healing phase of a fracture will help ensure optimal recovery from this injury.2
How common is a jones fracture?
Most metatarsal fractures occur at the fifth metatarsal. They peak by the third decade of life for people assigned male at birth (AMAB) and the seventh decade for those assigned female at birth (AFAB).1
Who is at risk of a jones fracture?
Jones fractures can affect anyone. The risk of having a Jones fracture is high if individuals regularly put a lot of stress on their feet in ways most people do not. This includes athletes, dancers, and workers who walk or stand most of the time. People AMAB around 30, and those AFAB over 70 are also more likely to experience Jones fractures than other groups. People with osteoporosis have an increased risk for all types of broken bones, including Jones fractures.
What can I expect if I have a jones fracture?
A Jones fracture will usually take about 6 weeks to heal. If affected individuals still experience pain and swelling for a further 3 to 6 months, then they may have to wear a boot or cast and initially attempt to keep their weight off the foot. They may also take painkillers to help with any pain.
After the fracture heals, recovering patients may be able to resume normal activities. However, some tasks may cause discomfort. Athletes may consider wearing a support recommended by a healthcare professional when returning to sports.5
When should I see a doctor?
Anyone who suspects they have a fracture should talk with a healthcare professional as soon as possible. If an injury is acute, which means it happens suddenly rather than over an extended period due to stress, make an appointment to see the doctor at an emergency clinic as soon as possible.
Jones fractures are one of the most common foot fractures. They are especially common in athletes, dancers, people with jobs that require them to be on their feet constantly, and the elderly who suffer from osteoporosis. This fracture can happen when a person increases their training, increases pressure on their feet from gaining weight, or runs on uneven surfaces. Individuals can expect a 6-week healing time if they avoid smoking and carry out movement exercises to improve circulation and avoid the risk of blood clots. If the foot does not fully heal from a Jones fracture and pain continues for a further 3 to 6 months, then a specialist doctor may recommend the foot be put in a cast and prescribe painkillers. In extreme cases, surgery may need to be carried out. Smoking, diabetes, and osteoporosis can delay the healing of Jones fractures.
- Smidt KP, Massey P. 5th metatarsal fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jul 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK544369/
- Chloros GD, Kakos CD, Tastsidis IK, Giannoudis VP, Panteli M, Giannoudis PV. Fifth metatarsal fractures: an update on management, complications, and outcomes. EFORT Open Reviews [Internet]. 2022 Jan 11 [cited 2023 Jul 7];7(1):13–25. Available from: https://eor.bioscientifica.com/view/journals/eor/7/1/EOR-21-0025.xml
- Lareau CR, Anderson RB. Jones fractures: pathophysiology and treatment. JBJS Reviews [Internet]. 2015 Jul 28 [cited 2023 Jul 7];3(7):e4. Available from: https://journals.lww.com/jbjsreviews/Citation/2015/07000/Jones_Fractures__Pathophysiology_and_Treatment.4.aspx
- Metzl JA, Bowers MW, Anderson RB. Fifth metatarsal jones fractures: diagnosis and treatment. JAAOS - Journal of the American Academy of Orthopaedic Surgeons [Internet]. 2022 Feb 15 [cited 2023 Jul 7];30(4):e470. Available from: https://journals.lww.com/jaaos/Abstract/2022/02150/Fifth_Metatarsal_Jones_Fractures__Diagnosis_and.6.aspx
- Le M, Anderson R. Zone II and III fifth metatarsal fractures in athletes. Curr Rev Musculoskelet Med [Internet]. 2017 Feb 20 [cited 2023 Jul 8];10(1):86–93. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344859/