John Goodner

Unlikely, but not impossible. Jones fractures are fractures of the fifth metatarsal that occur in an area of the fifth metatarsal that has a poor blood supply. Jones fractures are more common in active people and are very common in football, basketball and soccer players. These fractures have often been described as excessive stress to the fifth metatarsal, especially with the foot pointed in a down position in which the ankle also rolls to the outside. This is also commonly seen in athletes that have a high arch foot or ones that have the front part of the foot turned in relative to the back part of the foot (met adducts).
Pain in the fifth metatarsal in an athletic person should often be evaluated relatively quickly after it is felt. Stress to the fifth metatarsal may weaken the bone, predisposing it to more simple trauma that can break the bone in an area with poor circulation. Initial x-rays may be necessary but if the clinical exam is consistent with an injury, MRIs may be necessary to further evaluate the injury. If MRLs do show that there is bone marrow edema then this injury should be treated with a period of immobilization to allow the area to heal. Failure to address this when it is in a pre-fracture stage may predispose the athlete to further injury.
If the x-ray does show that the bone has fractured in the region with poor circulation, conservative and surgical treatment options are offered. Conservative care includes a non weightbearing cast for eight weeks. A return to sports may be 3-4 months. There is a high risk of refracture to this area in athletes with a high arch foot. In those patients, surgical treatment may be performed initially to allow the fracture to heal more rapidly and return the athlete back to sporting activity. This would require non weightbearing for six weeks in a boot. Athletes can usually return to activity following the use of screw fixation in approximately 10-12 weeks. If the foot has an excessively high arched posture in which the heel bone is turned under, surgery in the rearfoot may also be necessary at the same time to get the heel bone straight and take the stress off of the outside of the foot. A procedure on the heel bone usually recovers more quickly than a procedure on the metatarsal.

Surgery when performed is done on an outpatient basis under a twilight anesthetic. An incision of approximately 1/4" is placed on the side of the foot. Through this incision, a small pin is placed into the bone. A screw is then applied over the pin to compress the fracture and allow it to heal more rapidly. The size of the screw depends on the size of the bone. We usually employ a 4.5 mm titanium screw in females. In athletic males who have much larger bone screws that are 5.5 mm to 7.0 mm may be necessary. In athletes, we prefer solid screws over partially threaded screws. We have had great long-term success in healing patients with these fractures. Patients are typically allowed to bathe 2-4 days after the procedure, as only one stitch is used. Although they are non weightbearing they can get into the gym very quickly and work their upper body. Leg extensions and leg curls can also be performed. We have found a period of non weightbearing for six weeks is typically best. However, x-rays and clinical exams are important to assess how the patients are healing. A return to walking in a boot is usually performed at week 7 or 8. If the fracture is healing as expected sneakers and an orthotic device in their shoes utilized in running can begin between 8 and 12 weeks depending on the clinical exam and x-rays. A return to active sports may take 10 or more weeks. We typically do not allow athletes to return sooner for fear of reinjury to the bone or fracturing the screw.

Jones fractures can often go on to delayed union. This means that the fracture is not healing in the expected time. In those cases, bone stimulators may be used to help accelerate the healing process. In some cases, this fracture may go on to a nonunion. Nonunions of the fifth metatarsal can become very painful and cause a disability in a running athlete. It will most often require surgery to remove the areas of the bone that are devoid of blood supply. A bone graft is then applied to the fracture and a small plate or screw is utilized to stabilize the fractured area. Nonweightbearing for 8-12 weeks would be mandatory. The long-term prognosis is excellent. If there is a foot deformity that predisposes the patient to increased stress to the fifth metatarsal, surgery would be necessary for these other areas to unload the fifth metatarsal more permanently.

The bruising with associated swelling and pain is concerning. I would recommend an MRI to rule out ligament, tendon, cartilage injury etc.

I would recommend an x-ray to rule out a fracture and an offloading shoe or boot.

If the pain is not improving after 1 month, I would recommend for your parents or legal guardian to take you to see a foot and ankle specialist for an exam and imaging studies.

After an x-ray is performed, it will be determined if any intervention is indicated.

Dependent on fracture type and severity; treatment options range from taping, splinting, offloading shoes/boots, closed reduction of the fracture with local anesthesia, percutaneous pinning, or open reduction internal fixation of toe fracture.

Anesthesia options for toe surgery include: Local anesthesia, monitored anesthesia care, regional anesthesia, and general anesthesia.

Every patient will have a different threshold for pain. Pain level can also depend on the extent of the surgery. All surgery will create some pain or discomfort to a certain degree. With regional anesthesia and a multi-modal pain medication plan, the majority of my patients have expressed very little discomfort after surgery and that their pain is well controlled.

The duration of surgery depends largely on the extent of the ankle ligament repair, severity of the ankle deformity or injury, and hardware or implant selection. It can range anywhere from 1 to 3 hours depending on what procedures are being done, how many ligaments are being repaired, and if any adjunctive procedures are being performed, such as ankle arthroscopy.

In mild cases, bone spurs may develop around the ankle joint. A small degree of joint space narrowing may also be present. As arthritis progresses there is a further loss of joint space. The joint surface appears to be white and diffuse bone spurring develops around the joint region.
Treatment options include:
Mild cases: Braces - ankle, and foot orthoses, (AFOs) may help to decrease motion in the ankle joint, lessening the pain.
Moderate cases: When a conservative case has not helped, arthroscopic surgery to remove the abnormal bone, soft tissue, and cartilage may be of benefit. If the disease process is advanced, only temporary benefits may be achieved.
Severe cases: When arthritis has advanced and has been unresponsive to conservative care and/or arthroscopy, a fusion of the ankle joint is the gold standard. During the fusion, the cartilage and the joint surface are completely removed. The bones are then put together and held in place with screws. This procedure can be performed arthroscopically if there is a minimal deformity to the foot and ankle. If there is severe deformity the procedure may be performed open.
The long-term outcome is excellent following the procedure with regards to eliminating the pain. Most patients can return to walking without discomfort.
Some cases of severe arthritis may be candidates for Total Ankle Replacement surgery. This is a technique where the ankle joint is replaced by a prosthetic (artificial) ankle.

See a foot and ankle specialist and get an x-ray to ensure the position of the toes are adequate; the poor position can lead to arthritis and other conditions that require surgery in the future. Early and proper offloading of shoes and boots can expedite the healing process and protect from re-injury. Call the Foot, Ankle & Leg Specialists at South Florida Institute of Sports Medicine.



If you heard a crack, I would see a foot and ankle specialist for an x-ray to rule out fracture and receive proper offloading equipment. Call the Foot, Ankle & Leg Specialists at South Florida Institute of Sports Medicine.

Return to play is carefully determined by the Foot and Ankle Specialist based on the specifics of your sport or activity. Physical therapy is highly necessary for a full recovery and to minimize the recurrence of injury secondary to ankle instability. A gradual increase in activity is encouraged, usually at 10% increments per week. Low impact exercise usually begins once the ligaments appear clinically healed and proprioception is restored to the ankle joint. Sport specific rehabilitation can expedite the recovery of the patient and potentially lead to a faster return to play. Many patients and athletes may need an Ankle brace for several months after return to play is initiated.

Immediate care is necessary to prevent any long-term problems.

Mild injuries associated with minimal swelling may be treated with rest, ice, elevation and an ankle brace. 2-4 weeks for full recovery is typical.

Moderate injuries in which a partial tear has occurred may necessitate immobilization for 2-6 weeks in a removable boot or hard cast.

Severe injuries need to be immobilized in a hard fiberglass cast, or removable boot and brace combination, for 4-6 weeks to allow the ligaments to heal properly. Weight bearing is usually allowed. Sometimes these can take several months to fully recover depending on severity of injury.

Anti-inflammatories such as advil, ibuprofen, aleve, motrin or naprosyn should ALWAYS BE AVOIDED in the first 5-7 days of injury. Ligaments heal with accumulation of growth factors and scarring; these medications lessen inflammation which essentially reduces scarring. This is NOT a good thing to do. Acetominophen, Tylenol, is preferable for pain management, in addition to the Rest, Ice, Compression, Elevation protocols.

Physical therapy following bracing or cast removal is necessary to improve muscle strength, ankle stability, joint proprioception and to restore complete ankle range of motion. If left untreated, chronic instability commonly develops. Recurring twisting injuries then occur with minimal stress. This will require chronic use of an ankle brace and physical therapy. Prolotherapy can sometimes be performed to cause inflammation in an attempt to restore or increase stability. This is a series of weekly injections into the ankle ligaments, ultrasound guided with an irritant solution of Dextrose and Lidocaine (sugar water). Platelet Rich Plasma (PRP) injections may provide a stimulus to healing If there is chronic instability, surgery would be necessary to surgically reconstruct the ligaments in the ankle and allow a full return to activity. In such cases, the prognosis is excellent.

The acute ankle sprain is the most common injury in sports. It is estimated that approximately 30% of individuals will develop chronic ankle instability after the first initial lateral ankle sprain. Simple ankle sprains are not as innocuous as many believe, with high rates of prolonged symptoms, decreased physical activity, recurrent injury, and self-reported disability. Routine non-operative treatment is successful in more than 90% of individuals. Surgery is reserved for those who fail bracing, proprioceptive training, and kinetic chain strengthening.

Physical therapy is highly recommended to improve the long term prognosis and minimize risk of chronic ankle instability, ankle impingement syndrome, or ankle arthritis.

Patients will remain nonweightbearing for six to twelve weeks, depending on the severity of the fracture.

Sedentary jobs can resume after one to three weeks. Work requiring extensive weightbearing may take six to twelve months. If the bone injury is severe, a change in a person’s job may be needed. Sports modifications will also be necessary.

Sedentary jobs will provide little problem for patients with calcaneal fractures. Work restrictions will be necessary for the person who has to weightbear. Walking long distances or standing for a period of time will adversely affect the foot. These restrictions may be in place for up to one year. In some cases these restrictions may be permanent.

With most types of less invasive foot surgery the patient will walk right away in an offloading shoe or boot. Depending on the severity or involvement of the surgery, a period of non weightbearing may be prescribed for a few weeks or sometimes months.

General anesthesia, Spinal anesthesia, Laryngeal Mask Airways and Regional anesthesia are used for more invasive ankle joint surgery.

Monitored anesthesia care with local anesthesia and Regional anesthesia are used for less invasive ankle joint surgery.

Ice, elevation and compression. Follow your foot surgeon's post operative pain medication protocol; try to stay ahead of your pain rather than catching up with it. Call your foot surgeon if pain is suddenly worsening or not alleviated with prescribed pain medication.

Physical therapy and a gradual rehabilitative exercise program.

Physical therapy and a graduated rehabilitative exercise program is highly recommended to avoid long term complications.

A foot and ankle surgeon will typically keep their patients non-weightbearing anywhere from 4-6 weeks to a few months depending on the severity of the fracture.