Athletes can get fractures in many locations, including the small bones in the feet.
A Jones fracture is a fracture at the base of 5th metatarsal (the long bone on the outside of the foot). These fractures commonly occur from twisting forces on the foot and can occur suddenly with an acute fracture or slowly over time as a stress fracture. Either way, these fractures cause pain and swelling on the outside of the mid-foot. Any weight bearing is painful, making it almost impossible to run, let alone cut or change direction. The fracture occurs at a part of the bone that has a limited blood supply, and this can affect healing as described below.
Jones fractures can occur to people in all walks of life. For most people, these fractures don’t need surgery. If this type of fracture is treated without surgery, the patient has to wear a special boot and walk with crutches to take stress off of the fracture and protect it while it heals, which may take at least six to eight weeks. However, sometimes the bone shows signs of delayed or non-union (non-healing), even after several months of treatment. This can usually be attributed to a poor blood supply to the area. In these cases, surgery may be necessary. This usually involves placing a special screw across the fracture, with the occasional addition of a bone graft, which acts to stimulate new bone growth.
When a high performance athlete has this type of fracture, they often undergo surgery right away. Obviously, they want to get back to competition as soon as possible, but waiting to see if the fracture heals may require more time than they’re willing to give. Therefore, they undergo surgery to stabilize the fracture, with or without bone graft. In order to speed up healing, in addition to a bone graft, a bone stimulator is used, supplying a weak electric current across the fracture site to encourage bone healing. Even with surgery, patients must wear a special boot and crutches to protect the fracture in the early healing phase.
X-rays are taken every week or two to confirm the fracture is healing. The athlete can participate in non-weightbearing fitness activities like upper body weight training and the ergometer. When there is evidence of healing, the athlete can slowly begin to bear weight again. It is important not to return to sport too early before the bone is healed, as these fractures can re-break and then the athlete has to start all over again.
After having surgery, the outside of the foot may be sensitive from the scar and/or the screw head. If the screw head appears to be part of the problem, it may be removed, but only after the fracture is well healed. Most athletes, and patients in general, eventually get back to all of their previous activities with little or no limitation – but, because of the limited blood supply in the region of a Jones fracture, complete healing may take longer than the six to eight weeks required for most other fractures.
Seth Gamradt, MD
2006 Sports Medicine and Shoulder Fellow
Hospital for Special Surgery