ID: 43 y/o ♀ previously healthy came in due to Rt foot pain and swelling.
HPI: Pain started suddenly 2wk ago in her dancing class. The pain came on suddenly with a direction change while practicing her steps. Thought it was a sprain, and did not seek medical attention. Pain and swelling did not resolve; pain is worse, does not radiate; constantly present but worse with weight bearing; interferes with walking, and work; causes limping; OTC NSAIDs help; ⊘ ankle pain;
Very active lifestyle;
PMH: Noncontrubutory
Meds: ⊘
All: NKDA
E/O: A + O ✗ 3; NAD; ⊘ ill/toxic
VSSA
Rt foot: Swollen compare to the Lt side; mild bruising mid foot region; 5th metatarsal (MT) base tender to touch; MTP and ankle joints Ⓝ painless ROM;
Neurovascular Ⓝ; ⊘ deformity;
Gait: antalgic;
Foot XR: proximal 5th MT # (Jones #)
Fig1(1)
I/P: A 43 y/o lady in good health, and active lifestyle with Jones#.
Pain management; non-weight bearing cast for 6-8wk. Outpatient F/U Ortho, next week.
Discussion:
Jones # is the fracture of the proximal 5th MT at the metaphyseal-diaphyseal junction(1.5cm distal to the tuberosity). Involves the 4th-5th MT joint.
Fig.2(2)
Should not be confused with the avulsion # of the 5th MT styloid which is more common (90% of the cases). Other DDx include, stress #, and os peroneum. If acute (≺3mo)+minimal displacement conservative Rx.
Recently more tendency in favour of early surgical management (earlier return to full weight bearing(wb) in 2-4wk)(3). Non union is potential concern in conservative Rx.
Stress # usually caused by overuse; more gradual onset of pain; may have Sx before +ve XR; distal to 4th-5th MT joint; more prone to nonunion.
References:
3. Brukner, P., Brukner, P., D.R.C.O.G, & Khan, K. (2009). Clinical sports medicine. North Ryde, N.S.W: McGraw-Hill.
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