5th Metatarsal Fracture: Is it a Jones fracture?

A 5th metatarsal fracture is one of the most common fractures of the foot. The fifth metatarsal is the long bone along the outside of the foot that connects to the little toe. Although all fifth metatarsal fractures occur in the same bone, the location of the fracture makes a major difference in how the injury is treated and how well it is expected to heal.

Patients are often told they have a “broken fifth metatarsal” or a “Jones fracture,” but these terms can describe different injuries. The proximal fifth metatarsal is commonly divided into Zone 1, Zone 2, and Zone 3 fractures. Understanding which zone is injured is important because Zone 1 fractures generally have a good healing potential, while Zone 2 and Zone 3 fractures have a greater risk of delayed healing, nonunion, and refracture.

In Greenville SC Dr. Michael Sims specializes in the diagnosis and treatment of foot and ankle fractures, including complex fifth metatarsal injuries and Jones fractures.

What Is a Fifth Metatarsal Fracture?

The fifth metatarsal is the long bone on the outside of the foot. A fracture can occur anywhere along this bone, from its base near the middle of the foot to the shaft and neck near the little toe.

Fifth metatarsal fractures can result from:

• Rolling or twisting the ankle

• A fall

• A sports injury

• An awkward landing

• Direct trauma to the foot

• Repetitive stress or overuse

Some fractures happen suddenly, while others develop gradually as a stress fracture.

One of the most important factors in determining treatment is where along the fifth metatarsal the fracture occurs.

The Three Zones of the Fifth Metatarsal

Proximal fifth metatarsal fractures are commonly classified into three zones:

Zone 1 – Tuberosity Avulsion Fracture

Zone 2 – Jones Fracture

Zone 3 – Proximal Diaphyseal Stress Fracture

This classification is clinically important because these three fractures have different mechanisms of injury, blood supply, healing potential, and treatment considerations.

Zone 1 Fifth Metatarsal Fracture

A Zone 1 fracture occurs at the tuberosity, which is the prominent portion of bone at the base of the fifth metatarsal.

These fractures are commonly called avulsion fractures or pseudo-Jones fractures.

A Zone 1 fracture often occurs when the foot rolls inward during an ankle sprain. The peroneus brevis tendon and the lateral portion of the plantar fascia attach near this area and can pull on the bone during an inversion injury.

Treatment of Zone 1 Fractures

Most nondisplaced Zone 1 fractures can be treated without surgery. Treatment may include:

• A walking boot

• A stiff-soled shoe

• Protected weight bearing

• Activity modification

• Gradual return to normal activity

Most patients progressively increase weight bearing as pain improves.

Surgery may occasionally be considered when the fracture is significantly displaced or involves a substantial portion of the joint surface.

Zone 2 Fifth Metatarsal Fracture: The Jones Fracture

A Zone 2 fracture is the classic Jones fracture.

It occurs at the metaphyseal-diaphyseal junction of the fifth metatarsal, just beyond the tuberosity. This area is particularly important because it lies near a transition in the blood supply of the bone. A relative vascular “watershed” in this region contributes to the increased risk of delayed healing and nonunion.

This is why a Jones fracture is treated differently from many other foot fractures.

How Does a Jones Fracture Happen?

A Jones fracture can occur from a sudden twisting or loading injury, particularly when the foot is planted and the forefoot is forced inward.

Jones fractures can also occur in athletes and active individuals.

Patients may experience:

• Pain on the outside of the foot

• Swelling

• Bruising

• Difficulty walking

• Tenderness directly over the fifth metatarsal

• Pain with running or pushing off

Some patients have pain for a period of time before the fracture becomes obvious, particularly when there is a stress component.

Why Are Jones Fractures Difficult to Heal?

The biggest concern with a Zone 2 Jones fracture is bone healing.

The metaphyseal-diaphyseal junction has a relatively limited blood supply compared with other areas of the fifth metatarsal. This can make the fracture more susceptible to:

• Delayed union

• Nonunion

• Persistent pain

• Refracture

Reported nonunion rates for Jones fractures can be significantly higher than those seen with Zone 1 fractures.

This does not mean that every Jones fracture requires surgery. Rather, the specific fracture pattern and the patient's individual needs need to be considered when selecting treatment.

Nonsurgical Treatment of a Jones Fracture

A nondisplaced Jones fracture can sometimes be treated without surgery.

Treatment may involve:

• Strict non-weight bearing

• Crutches

• A cast or walking boot

• Follow-up X-rays

• Gradual progression of weight bearing once healing is demonstrated

Nonsurgical treatment may require 6–8 weeks or longer of protection, and some Jones fractures require additional time before the patient can safely return to impact activities.

Because of the risk of delayed healing, patients with Jones fractures generally require closer follow-up than patients with a simple Zone 1 avulsion fracture.

Surgical Treatment of a Jones Fracture

Surgery may be recommended for certain Jones fractures.

Factors that may favor surgery include:

• Displacement of the fracture

• Delayed healing

• Nonunion

• Refracture

• High athletic demands

• Desire for a potentially more predictable and expedited return to activity

• Certain fracture patterns at higher risk for healing problems

One of the most common surgical techniques is intramedullary screw fixation. A screw is placed down the central canal of the fifth metatarsal to stabilize the fracture while it heals. Other fixation methods, including plates and screws, may be appropriate depending on the fracture pattern.

For competitive athletes, surgical fixation of Zone 2 and Zone 3 injuries is frequently considered because of the higher risk of delayed union, nonunion, and refracture with nonsurgical treatment.

Zone 3 Fifth Metatarsal Fractures

A Zone 3 fracture occurs in the proximal portion of the fifth metatarsal shaft, distal to the Zone 2 metaphyseal-diaphyseal junction.

These fractures are often associated with repetitive stress or overuse rather than one specific traumatic event. Athletes and people who participate in high-impact activities can be particularly susceptible.

Patients may notice:

• Gradually increasing pain

• Pain with running or exercise

• Tenderness along the outside of the foot

• Pain that improves with rest but returns with activity

In some cases, a Zone 3 stress fracture eventually progresses to a complete fracture.

Treatment of Zone 3 Fractures

Treatment depends on the appearance of the fracture, whether it is an acute fracture or stress injury, whether there is evidence of delayed healing, and the patient's activity level.

Some patients can be treated with prolonged immobilization and activity restriction. However, Zone 3 fractures have a greater tendency toward delayed healing and nonunion. In athletes and highly active patients, surgical fixation may be recommended.

What About Fifth Metatarsal Shaft and Neck Fractures?

Not all fifth metatarsal fractures occur at the base.

A fracture can also occur farther down the bone in the shaft or neck.

Fifth Metatarsal Shaft Fractures

Shaft fractures can occur from a direct blow, twisting injury, or other trauma. Some are relatively straightforward and can be treated in a boot or stiff-soled shoe.

However, significant displacement or angulation may require the bone to be reduced and surgically stabilized.

Fifth Metatarsal Neck Fractures

The neck is the portion of the metatarsal just behind the toe. Fractures in this area can result from direct trauma or an axial loading injury.

The treatment depends on:

• Amount of displacement

• Angulation

• Rotation

• Whether the fracture enters the joint

• The patient's activity level

Significantly displaced or angulated shaft and neck fractures may require reduction and fixation to restore proper alignment.

Fifth Metatarsal Fracture Treatment: Does Every Fracture Need Surgery?

No.

One of the most important points for patients to understand is that a fifth metatarsal fracture does not automatically require surgery.

Treatment depends on several factors:

1. Location of the fractureZone 1, Zone 2, Zone 3, shaft, and neck fractures behave differently.

2. DisplacementA fracture that has remained well aligned is more likely to be treated without surgery.

3. StabilityAn unstable fracture may require fixation.

4. Healing potentialJones and Zone 3 fractures have a higher risk of healing problems.

5. Activity levelTreatment considerations may be different for a competitive athlete than for someone who primarily walks for exercise.

6. Previous injuriesA fracture that has already failed to heal may require a different approach.

This individualized approach is particularly important with fifth metatarsal fractures because the same treatment does not work equally well for every fracture pattern.

How Long Does a Jones Fracture Take to Heal?

The recovery time for a Jones fracture varies considerably.

A patient treated nonsurgically may require 6–8 weeks or more of protected or non-weight bearing, followed by gradual progression of activity once there is sufficient evidence of healing.

Patients who undergo surgery still require time for the bone to heal. The goal of surgery is to stabilize the fracture and create an environment that promotes healing, not to make the bone immediately healed.

Returning to running, jumping, cutting, and competitive sports should occur only after appropriate healing and rehabilitation.

Why See a Foot and Ankle Specialist for a Jones Fracture?

The fifth metatarsal may look like a relatively simple bone, but the exact location of a fracture can dramatically change its prognosis and treatment.

Distinguishing a Zone 1 avulsion fracture from a Zone 2 Jones fracture or a Zone 3 stress fracture is an important part of treatment planning. The decision between a boot, cast, protected weight bearing, or surgical fixation should take into account the fracture pattern as well as the patient's goals and activity level.

Dr. Michael Sims is a fellowship-trained orthopedic surgeon specializing in foot and ankle surgery. His specialized training and focus on foot and ankle injuries provide expertise in treating fifth metatarsal fractures, including Jones fractures, stress fractures, shaft fractures, and other complex foot injuries.

Fifth Metatarsal Fracture Treatment in Greenville, SC

If you have been diagnosed with a Jones fracture or fifth metatarsal fracture, it is important to understand exactly where the fracture is located and whether it is likely to heal successfully with nonsurgical treatment.

A Zone 1 fracture is generally more likely to heal with conservative care.

A Zone 2 Jones fracture occurs in an area with a higher risk of delayed healing and nonunion and may require closer monitoring or surgical fixation.

A Zone 3 fracture is often related to repetitive stress and can be particularly challenging to heal, especially in active patients.

Fractures farther down the bone involving the shaft or neck have their own treatment considerations based primarily on alignment and stability.