The physician may advance weight-bearing status as radiographic evidence of bone healing appears. Nondisplaced zone 2 injuries, or Jones fractures, may also be treated conservatively with 6 to 8 weeks of non-weight bearing in a short leg cast. Fractures involving 30% of the articular surface or with an articular step-off over 2 mm have treatment with open reduction, internal fixation, closed reduction, and percutaneous pinning or excision of the fragment. Progression to weight-bearing as tolerated can initiate as pain and discomfort subside over 3 to 6 weeks. Nondisplaced zone 1 injuries can be treated conservatively with protected weight-bearing in a hard-soled shoe, walking boot, or walking cast. Treatment decisions have their basis on the anatomic zone of injury, the social and medical history of the injured patient, and evidence of radiographic signs of healing. A vascular watershed area exists in zone 2, contributing to the high nonunion rates seen with these fractures. Metaphyseal arteries and diaphyseal nutrient arteries provide the blood supply to the fifth metatarsal base. Additionally, a patient may sustain a shaft fracture greater than 1.5 cm distal to the tuberosity, a long spiral fracture extending into the distal metaphyseal area, the so-called dancer's fracture, or a stress fracture of the metatarsal.Ĭlassification of these fractures is crucial to making management decisions. Fractures through zone 1 are called pseudo-Jones fractures, and fractures through zone 2 are referred to as Jones fractures. Nevertheless, it is critical that the clinician recognizes all injury patterns of the fifth metatarsal and initiate the appropriate treatment plan or referral process to avoid potential complications.Ĭlassified by Lawrence and Bottle, the base, or proximal aspect, of the fifth metatarsal is broken up into three anatomical zones: zone 1, the tuberosity zone 2, the metaphyseal-diaphyseal junction and zone 3, the diaphyseal area within 1.5 cm of the tuberosity. Since orthopedic surgeon Sir Robert Jones first described these fractures in 1902, there has been an abundance of literature focused on the proximal aspect of the fifth metacarpal due to its tendency towards poor bone healing. Foot fractures typically take 10-12 weeks to fully heal.Fractures of the fifth metatarsal are common injuries that must be recognized and treated appropriately to avoid poor clinical outcomes for the patient.I would like to see you back in 4 weeks for a follow-up appointment.Outside of the walking boot/post-op shoe, you should limit yourself to cycling on a stationary bicycle.There are no limitations to your activities, as long as they are performed in the walking boot/post-op shoe.Hold each stretch for a five-count and do five repetitions. Stretch the Achilles by placing a towel across the ball of your foot and pulling up.You should perform 3 sets of 15 reps of dorsiflexion (up) and eversion (out), but avoid plantarflexion (down) and inversion (in).You should perform the following exercises once in the morning and once in the evening: While in the walking boot/post-op shoe, I would like you to come out of the walking boot/post-op shoe twice daily to work on the following exercises.I would like you to remain in the supportive shoes for a total of 2 weeks before gradually returning to all types of shoe wear.At 4 weeks post-injury, you may gradually transition from the walking boot/post-op shoe back into stiff-soled, supportive shoes.The walking boot is in place to protect rather than immobilize the fracture. You may remove the walking boot/post-op shoe whenever seated or lying down, in a safe environment.I would like you to discontinue use of crutches or any other assistive walking devices as quickly as possible. You are allowed to fully weight bear as tolerated in the walking boot/post-op shoe.You should remain immobilized in a walking boot/post-op shoe until 4 weeks from the initial injury.
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