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Jones Fracture / Non Union Fracture

by Sue
(Branford, CT)

I broke my foot last June (5th Metatorsal) I re broke it end of Dec 2013. Both times it was eggplant color from the blood loss when the bone broke! Around the entire foot for a few weeks. I have Osteoporosis which doesn't help. Plus other medical issues. The fracture still had not healed, I have done the bone stimulator for months I also take high doses of Vit D. I still have a lot of pain in foot daily, I get these zingers that my dr is not sure what they are from, I looked it up, it said it was nerves which makes sense I mean the zingers stop me dead in my tracks, so painful and I feel sometimes like I'm crazy when I go to the Dr like she thinks I shouldn't be in pain and why am I still coming?? She wants to discharge me next time! But I feel like I'm not healed so how could that be? I feel like after the 2nd break I should have had a cast not a walking boot to stabalize my foot. I don't know how to handle this continued pain. They couldn't do surgery because I would be walking on a screw I understand that but geez it's over a year now I feel like am at a stand still and I can't believe this is how it is going to be? I am really discouraged and so afraid of breaking the bone again.

I am looking forward to hearing your opinion and your suggestions.
Thank you

RESPONSE

Hi Sue,

Perhaps it is time to find a new doctor. As you may have read on this site or perhaps another medical site, fifth metatarsal base fractures have a high propensity towards a non-union due to the inherently poor blood supply to this area of the bone.

After the first break in June 2013, it was not unreasonable to treat the fracture conservatively. This kind of treatment would be predicated on a number of issues including the degree of osteoporosis, plus the size the gap (the space created between the two ends of bone}, as well as other factors such whether or not you are a smoker, some metabolic diseases will delay healing as well.

Assuming your doctor felt there was a good chance your fracture would heal with conservative care, then a walking boot and bone stimulator would have been one option for you.

The problem became more dubious when you fractured the bone a second time in December 2013. A second fracture would have told me that the chances of your Jones fracture ever healing well was very much diminished. As a side note, you do not mention whether or not the second fracture was the result of a trauma, or the bone just re-fractured from simply walking on it. If the latter was the situation, then as far as I am concerned you had no other choice but to consider surgery.

Continuing with a bone stimulator and going non-weightbearing through the use of a cast and crutches was a lesser option for the simple reason, how long do you want to be dealing with this? Most people finally reach the conclusion that surgery, even though no one really wants it, is a better alternative then spending over a year dealing with this particular problem.

The "zingers" you mention, tell me that the bone is still broken and quite frankly I am surprised that your doctor cannot understand what is going on. Hopefully, you are seeing a foot specialist and not using your general doctor.

So, if your x-rays look like the bone is healed and you are still having pain then you should consider a bone scan or an MRI which will show fractures that are not evident on x-ray. I am really going out on a limb here, but I am willing to bet that even an x-ray will show that the fracture has not healed. I say this because of the amount of pain you are still having and the fact that you have broken the same bone twice in a short period of time.

Let me also add another point that annoys me. How can your doctor tell you not to have surgery because you will have a screw in your foot? Screws are inserted on a routine basis for Jones fractures that do not heal and require surgery. The screw does not go into the bottom of your foot and so even though it is in your foot, you are not actually walking on it. Unless there are circumstances that I am unaware of, that is ridiculous advice. What does she expect you to do, walk around in pain for the rest of your life?

At this point, you may also require a bone graft as well as hardware to secure the fracture site due to the fact a non-union of this duration will require the fracture site to be cleaned out of fibrous tissue and replaced with bone in order for the fracture to adequately heel once you have surgery.

As I said at the start of my response, find yourself another doctor in your area.

Marc Mitnick DPM
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Aug 08, 2014
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Foot
by: Sue

Can you recommend a doctor to me in my area? I would appreciate it

Sorry, I do not know specific doctors in various parts of the country. I would suggest you call your local hospital and get a recommendation, or ask your primary care doctor for a recommendation.

Aug 07, 2014
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Suggestion
by: Sue

Can you please tell me what my options are or would be at this point in the game? With my osteoporosis and I have Lupus and a IGG deficiency, for which I have an IV treatment every month, what would you suggest as an option? I heal very slowly. As you can tell. With this all said, I am so afraid of falling and breaking my foot and any bone at this point.

Hi Sue,

Without being able to actually examine you and see x-rays, my best advice is to get a second opinion from a doctor in your area who will have all the facts available and then be able to offer advice.

Marc Mitnick DPM

Aug 07, 2014
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Thank You
by: Sue

Thank you for your response. Yes my foot is still fractured. My last X-ray July 22nd showed that also an MRI in June. My Dr just feels it is something time will heal on it's own and that's it. I feel again a second time, I tripped on my stairs going up them. That was the second break.

Hi Sue,
The liklihood of a Jones fracture healing on its own, over time, is close to nil. It has now been seven months. A non-union by definition means that fibrous/scar tissue has filled the gap between the broken bones; this cannot be replaced by bone.

Fibrous tissue is not nearly as strong as bone and that is why there is still pain because there is motion in the fracture site.

You have to decide how much pain you want to be in and how long you want to deal with this issue and then take the appropriate actions.

Good luck
Marc Mitnick DPM

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