Jones Fracture

Metatarsal fractures are among one the most common fractures of the foot in primary care units. Among these, the most common location is the fifth metatarsal base (Jones fracture). There are numerous predisposing factors such as obesity and anatomic characteristics that lead to an overload on the lateral aspect of the foot. Etiology of these fractures includes trauma involving forefoot adduction, plantarflexion, hindfoot inversion, and repetitive microtrauma. Patients usually present with pain on the lateral border of the foot which worsens with weight-bearing. In cases of stress fractures, prodromal pain might be present. Diagnosis is usually made with history of trauma or repetitive microtrauma, physical examination, and associated plain radiographs (anteroposterior, lateral, and oblique foot). Computer tomography scan is usually reserved for complex comminuted fractures and to evaluate degree of healing on follow-up. Bone scans play a small role in stress fractures when radiographs are equivocal. Magnetic resonance imaging is only indicated when both radiographs and bone scans are equivocal and there is a high suspicion for stress fracture. Different classification systems have been proposed, although the most commonly used are the Lawrence and Botte’s (zone I/II/III) classification for acute fractures and Torg’s classification when delayed patient presentation occurs. Treatment usually varies according to the type of fracture, time of presentation: acute versus delayed, and patient demand. Conservative treatment is usually preferred for zone I (pseudo-Jones) fractures with surgery reserved for cases of delayed symptomatic presentation. Treatment of zone II (“true Jones”) and III is controversial and should be tailored to the patient’s needs. Low demand patients should undergo conservative treatment with no weight-bearing, while high demand patients, such as athletes, should undergo surgical treatment as it results in a lower return to sports time. Surgical treatment has been shown to be superior with intramedullary cannulated screw.