To surgically fix or not to fix a Jones Fracture. That is the question!

Jones Fracture treatment

What is a Jones Fracture?

The fifth metatarsal is a bone on the outside portion of your foot that has a natural bony protuberance called the styloid process. The styloid process is important area where soft tissues attach, like the peroneus brevis tendon and the lateral band of the plantar fascia.

Jones Fracture treatment

There are multiple types of fifth metatarsal fractures that can occur and the location of the fracture (such as the outside of the foot, the fifth metatarsal base or fractures of the proximal fifth metatarsal) factors into treatment.

Fractures of the fifth metatarsal, like an avulsion fracture, is when the tip of the styloid process of the 5th metatarsal is broken off of the bone due to the pull of the peroneus brevis tendon. This type of fracture is not considered a true Jones fracture (also known as a “pseudo-jones”).

A true Jones fracture is located about 1.5 -3 cm from the styloid process of the 5th metatarsal at the metaphyseal-diaphyseal junction.

How did a Jones Fracture get it’s name?

The name Jones fracture is derived from Sir Robert Jones who wrote about the fracture in Annals of Surgery in 1902. His discussed the findings of the fracture in 6 patients with himself being one of the patients. He sustained a fifth metatarsal fracture after a night of dancing where he noted aside from a traumatic injury, overloading and applying continued stress along the bone can lead to fracture1.

Why are Jones Fractures challenging to treat?

Part of the challenge with a true Jones fractures is the location and relative blood supply. Near the styloid process, there is a blood supply from the metaphyseal arteries and further along the shaft of the bone, the nutrient artery supplies the bone. Jones fractures are located in an area where there is a tenuous blood supply to the bone.

This type of fracture can occur after an injury involving inversion of the foot. It has also been linked certain foot types like those with a higher arch or metatarsus adductus as these foot types place more strain on the 5th metatarsal. Fleischer et al reported patients with these foot types are about 2.4 times more likely to have a Jones fracture2.

In order to diagnose the fracture, x-rays of the foot is required. Additionally, the foot will be swollen, bruised, tender to touch and patients will find it challenging to ambulate on the extremity. Sometimes additional imaging in the form of a computed tomography (CT) or magnetic resonance image (MRI) are required.

Non-surgical Jones Fracture Treatment Options

Conservative treatment requires immobilization in order to avoid motion across the fracture and keeping your foot non-weight bearing  Our physicians and orthopedic surgeons vary in their preference of cast versus immobilization boot. The issue most often encountered with an immobilization boots is patient will tend to remove them and/or walk on the fracture site. This can create motion across the fracture site delaying healing.

It generally takes bones 6-8 weeks to heal. However, the healing with this fracture  can take longer than other areas and can take 5 months to heal. In some studies, there is as high as a 50% refracture and nonunion rate. The reason for the delayed healing time is due to the areas poor blood supply           .

Surgical Jones Fracture Treatment Options

Surgical intervention will not make the bone healing faster than nonsurgical treatment, however, patients can return to ambulation quicker with less likelihood of refracture. Patients who undergo this procedure are typically more elite athletes.

In a sports medicine study of 25 football players for the National Football League players who sustained a Jones fracture, on average, they were able to return to play in about 8.7 weeks 3. This return to play time is significant as those who do not undergo surgery would not return to high impact activities that quickly after such an acute injury.

The typical orthopaedic surgical technique utilizes intramedullary screw fixation. There are some situations when a plating technique may be required for greater internal fixation.

Should I surgically fix a Jones Fracture?

Well, as the headline of this blog said, that truly is the question.

The decision of how to treat a Jones fracture depends multiple factors and requires a conversation between the patient and your surgeon so you can discuss and evaluate your numerous options.

If you or a family member suffered from a Jones fracture, we are available to help.

Why choose University Foot and Ankle Institute for your foot care?

If you’re experiencing problems with your feet or ankles, we’re here to help. Our nationally recognized foot and ankle specialists offer the most advanced podiatric care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

For more information or to schedule a consultation with a podiatrist, please call (877) 736-6001 or make an appointment online now.

  1. Jones, R. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Ann Surg. 1902; 35 (6): 697–700. 
  2. Fleischer AE, Stack R, Klein EE, Baker JR, Weil L Jr, Weil LS Sr. Forefoot adduction is a risk factor for Jones fracture. J Foot Ankle Surg. 2017;56(5):917-921.
  3. Lareau CR, Hsu AR, Anderson RB. Return to play in National Football League players after operative Jones fracture treatment. Foot Ankle Int. 2016;37(1):8-16.

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