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Jones fracture

I was diagnosed with a jones fracture December 25, 2013. I have been to 2 doctores and now very confused. The first one wanted to do surgery so I went for a second opinion. He wants to wait 3 weeks and do more X-rays. I am in a boot and he told me I could walk on it but it really hurts now worse than ever. It had felt better. So please give me some advice. My common sense tells me to listen to my body and stay off it. Should I see another doctor who specializes in the foot. Both these doctors were orthopedic surgeons. They did say I broke it in a very bad place a little further back or a little further up would have been better. Thank you so much. I appreciate any advice.


RESPONSE

Hi,

Any time you sustain a fracture, your doctor will evaluate the degree of "break" to determine appropriate treatment. If you doctor deems the separation of bone to be too far apart so that it will not heal on its own, then surgery is usually recommended.

However, if there is a chance the broken bone will heal on its own, then surgery is not recommended as surgery is always the last resort for any type of medical problem.

As you can imagine not all fractures are the same and one of the things that makes fractures different is the location of the break.

A Jones fracture is a fracture of the base of the fifth metatarsal bone. The problem with this particular location is that this particular part of the the fifth metatarsal bone is poorly vascularized, meaning it does not get as much blood to it as does the rest of the fifth metatarsal. Without adequate blood supply to an area, the chances of the fracture healing are diminished, even if there is not too much separation between the two ends of the break.

Assuming you are reasonably young, in good health, do not smoke (that too compromises circulation), the separation between the break is not too great, then a non-surgical approach should be taken with the understanding that there is still a possibility the fracture may not heal. Of course, one could argue that there is a chance any fracture, any where in the body may not heal.

So you are put in a walking cast and are now finding that it is painful to walk.

In cases of non-surgical approaches to a Jones fracture, I tend to have my patients non-weightbearing with the use of crutches. Since this type of fracture has a higher incidence of not healing, being non-weightbearing is a better option than bearing weight on the foot. Secondly, because of the location of the fracture, it tends, more often than not, to be aggravated by the side of boot pressing on the broken bone.

To take this one step further, if your insurance will cover it, you should inquire about a bone stimulator which can be very helpful in getting the fracture to heal in a normal period of time.

The risk with the conservative approach to treating a Jones fracture is if it does not heal, you have essentially wasted six to eight weeks and now have to consider surgical intervention.

Marc Mitnick DPM
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