Jones fracture/stress fracture

by Walter
(Norway)

Hi....

Got my fracture over time by overloading my foot, and maybe twisting it light a couple of times. Think i could have happened for at least a month ago, and it has been a mild fracture for some weeks. Very little pain and no brushing. But the pain got a little worse and i went to my doctor for an xray, which showed a mild fracture.

I got a cast for 4 weeks and NWB, and then a check to see how it is doing. So now i am in week 3.

I am just wondering what you think of the xray which was taken the day i got my cast....is it hope for removing cast in 4 weeks....? My opinion is that it is a very mild fracture, i've been trying to collect information on the internet but i can't find xreys of a Jones/stress fracture as mild like mine is.

Hope you can tell me my story ;-)


Walter

RESPONSE

Hi Walter,

I do not really like to make a diagnosis based on a small digital image, but based on what you presented to me, I would be hard pressed to state that you have a fracture. If the little white arrow is pointing to a fracture, I am hard pressed to be in agreement.

In cases like this, the more accurate way to diagnose a fracture would be through the use of a bone scan. The bone scan would be "hot" if there is osteoblastic activity going on. Osteoblasts are the cells that build bone.

So the question becomes one of if there is no fracture, why were you having pain in the area?

Possibly, the more likely answer would be due to irritation of the peroneal tendon that attaches into the base of the fifth metatarsal, the area where you are having pain.

Assuming the possibility that this is either an irritation of the peroneal tendon, or even a stress fracture the good news is that four weeks of being non-weightbearing should heal either problem.

I do not know your age or any thing about your medical history, but making the assumption that you are reasonably young, you are a non-smoker and are in good health then I would hope that you would be fine when the cast is removed.

As you have probably read in doing your research, the problem with fifth metatarsal base fractures is the fact that the area is poorly vascularlized and for that reason healing can take longer and in some cases might not occur at all. That would be the only reason that four weeks might not be enough.

If for some reason you are still having pain once the cast is removed, then a bone scan or perhaps even an MRI might be an option for you. An MRI can also pick up small fractures as well as picking up any abnormality with the tendon attaching into the bone, such as a possible tear or irritation.

Then depending on what the end result is, appropriate treatment can be initiated.

If it turns out that there is actually a stress fracture (although I have my doubts), you could then consider a bone stimulator, which is a device that helps promote healing of fractures.

On the other hand, if it turns out that there is soft tissue pathology such as tendon or even a ligament issue, then a round of physical therapy may be indicated.

Marc Mitnick DPM
DISCLAIMER