28 Feb Jones Fracture: Causes, Treatment, and Exercise Strategies
Got a nagging pain on the outside of your foot or pinky toe that just won’t go away? Are you an athlete that does repetitive jumping or running activities? You may have a Jones fracture! A Jones fracture is a break in the shaft of the bone of the 5th metatarsal (pinky toe) and most often results from repetitive strain. It can also be caused by acute trauma, such as dropping an object on your foot. Either way, it is treatable and does not have to interfere with the things you love to do every day! In this article, we will discuss the Jones fracture, its causes and symptoms, treatment and management, and some rehabilitative jones fracture exercises to get you back on your feet stronger than ever!
What is a Jones fracture and what causes it?
As stated above, a Jones fracture is a break of the 5th digit of the foot. It is usually clearly demonstrated on a standard x-ray (see photo below), and usually the result of repetitive motion strain. It can also be caused by a traumatic event, such as dropping an object directly onto the fifth digit (ouch! Hurts just thinking about it!). Of note, a Jones fracture is one of the most common, yet most severe fractures that can occur in this area of the foot. It is not the ONLY type of fracture – other types such as avulsion and spiral fractures can occur, although not as commonly.
The area where a Jones fracture occurs is in between the base and the shaft of the 5th metatarsal. This is particularly problematic for healing, because this area receives less blood flow than other areas of the foot. Therefore, healing can be slow, and in addition, treatment strategies may or may not include a surgical option for this region. Read more about tissue healing here!
How do I know if I have a Jones fracture?
If an acute injury, such as a fall or dropping an object on the foot occurs, you should seek care immediately. The provider will likely take an x-ray to diagnose the presence of a fracture, and may put you into a walking boot or other brace. They will then likely recommend a course of action to bring you through the healing and rehabilitative process. A topic we have discussed in a previous article is knowing if you would need an X-Ray after a foot/ankle injury, such as an ankle sprain. A validated clinical screening tool that is often utilized is the Ottawa Ankle Rules. This clinical tool is applicable to the foot region as well. To read more about the Ottawa Ankle Rules and to help you understand if you should seek imaging after an injury, click this link! You can also watch the video below to learn more about the Ottawa Ankle Rules.
Ottawa Ankle Rules To Rule Out Fractures
Signs and Symptoms of a Jones Fracture
If there is no acute injury and you are experiencing pain at the base of the 5th digit, the answer may not be as straightforward. Common signs and symptoms of a Jones fracture include:
- Sharp, pinpoint, localized pain
- Inflammation and/or redness
- Difficulty with walking and performing daily activities
- Numbness and/or tingling in the foot or toes
- A change in gait pattern by placing more weight on the inside of the foot due to pain on the outside of the foot
More serious symptoms, such as fever, purple discoloration in the foot and ankle, and severe, unrelenting pain should be reported immediately to a medical doctor.
Is your foot injury actually an ankle fracture? Read this article by us to find out what to do!
The Great Treatment Debate: Surgery or No Surgery?
Do you need surgery to repair a Jones fracture? It depends on many factors, such as age, athletic ability and activity level, and severity of the fracture itself. With the Jones fracture, there is a high risk of non-union due to the location of the fracture and poor blood flow, as previously mentioned. Non-union refers to the inability of the bone to “unify” and close back together after a fracture, as viewed on a plain radiograph (x-ray). Presence of non-union or delayed healing in the fracture may alter the course of treatment to include a surgical option, so that a person can return back to normal activity in a shortened amount of time.
In a study conducted in 2020 by Wang et al (1), a systematic review was conducted to explore the benefits of surgical versus non-surgical management of a Jones fracture. The study analyzed support for surgical management for the reduction of non-union rate, shortened duration of return to activity and sport especially for the athletic population, and lower pain levels during the healing process. On the other hand, additional studies by Brogan et al (2) and Dean et al (3) demonstrate safe, effective treatment with a non-surgical approach, usually including a walking boot or cast, to minimize complications that can arise from surgery, as well as keep treatment cost effective.
Surgical treatment usually consists of an internal fixation approach, meaning placement of screws and a bone graft procedure. With the non-operative approach, a person is usually placed in an immobilization cast or boot to facilitate healing in a non-weight bearing fashion.
Generally speaking, current research appears to strongly support surgical interventions for: those at high risk of non-union and delayed or poor healing, and high level athletes who need a quicker return to sport. Non surgical options are also deemed to be safe and effective (4), and a great option to reduce cost and pain and discomfort while healing, as well as a great option for those who are not concerned about prolonged healing time.
Exercise and Rehabilitation for a Jones Fracture
Whether you are treated with a surgical or non-surgical option for the Jones fracture, it is imperative to strengthen and rehabilitate the foot and ankle complex following the fracture once bone union is demonstrated on a plain radiograph and it is deemed safe to do so. Exercise rehabilitation should be focused on return to safe weight bearing, strength and conditioning of the foot and ankle, and neuromuscular retraining including proprioceptive feedback. By having good foot and ankle motion, we are able to be a lot more functional in our daily activities! Check out this podcast to learn more!
Whether surgical or non-surgical treatment is most appropriate, you usually will start with the foot immobilized to allow tissue healing to occur without disruption to the injured site. Remember, just because you are in a boot does not mean that you are unable to exercise! There are plenty of exercise related activities that you can work on while still being immobilized in a boot or cast. Read how to stay strong after surgery!
Below are some great exercises to get you started on your journey back to function, and the activities that you love!
4 Way Ankle Isometrics
Isometrics are a good place to start for jones fracture exercises, especially during the early phase of rehab. This avoids any disruption of the healing process while promoting early activation of the muscles surrounding the foot and ankle! Place one foot on the ground with your knee bent. Use your hand to resist the motions of your foot – to the side, up, down, in and out. You should feel the muscles of your foot and lower leg working! Perform 2x/day, hold :20 seconds each position.
Y Balance Exercise
Jones fracture exercises should also place a heavy emphasis on retraining balance and foot intrinsic strength! Get into a standing position, balancing on one foot on a firm surface. Start reaching using your opposite foot into a Y-formation, as shown in video. Maintain a foot flat position for the whole exercise. You should feel your planted foot working hard to maintain balance! If you want to learn more advanced exercises for the ankle, read this article!
Perform 10 times through, 2x/day.
Foot On Wall – Calf Stretch
Stretching is another important component of jones fracture exercises. This exercise is designed to stretch your calf and bottom of the foot and will help to alleviate pain. Place your foot up on the wall as high as what feels comfortable. Drive your knee toward the wall, feeling a stretch in the calf and bottom of the foot. Avoid driving the knee to the side; make sure it heads straight for the wall! Perform for 30 seconds, 5 times through, 2x/day.
Looking for more information on how to strengthen your feet and ankles? We’ve got a program for you!
The Foot & Ankle [P]Rehab Program is a physical therapist developed, step-by-step program that teaches you how to optimize your foot & ankle health. This 3-phase program will expose you to various foot & ankle strengthening and stabilization exercises supported by science. This program will bulletproof this region for anything life throws at you! Learn more HERE!
Jones Fractures can be a challenging injury to diagnose, especially if one waits to seek medical consultation. The poor blood supply to this specific area of the body makes this fracture susceptible to poor healing, which is why it is important to consult with a trained healthcare professional if you begin to feel pain towards your 5th digit of your foot. This will ensure that you not only receive a formal diagnosis, but also able to get back on your feet before you know it!
1.Wang Y, Gan X, Li K, Ma T, Zhang Y. Comparison of operative and non-operative management of fifth metatarsal base fracture: A meta-analysis. PLoS One. 2020;15(8):e0237151. Published 2020 Aug 13. doi:10.1371/journal.pone.0237151
2. Bucknam RB, Scanaliato JP, Kusnezov NA, Heida KA, Dunn JC, Orr JD. Return to Weightbearing and High-Impact Activities Following Jones Fracture Intramedullary Screw Fixation. Foot & Ankle International. 2020;41(4):379-386.
About the Author
[P]REHAB Writer & Content Creator
Taryn was born and raised in Maine and still resides there with her boyfriend and son. Taryn received her Doctorate in Physical Therapy from Husson University in 2010, and also carries a Bachelors in Kinesiology and Human Movement Science. She is a Certified Lymphedema Therapist, a Certified Crossfit Level 1 Trainer, and a NASM Certified Nutrition Coach. Taryn has 10+ years of experience in many different realms of PT, from the young athlete to the geriatric patient. Taryn considers herself a ‘lifelong learner’. She has special interests in oncology care and breast health, dry needling, and Crossfit training. In her free time, Taryn enjoys fitness, spending time with her family, continuing education, writing and reading, and is very excited to be a part of The [P]Rehab team to educate and empower others to take control of their own health and wellness.