Dr. Chi joined Shannon O’Kelley from IRG Physical Therapy on KOMO Health Talk to discuss the Jones fracture, a fairly common but complex fracture of the 5th metatarsal. Together, the two discuss the foot and ankle from an anatomical standpoint and then review Jones fracture specifically. Learn about signs, symptoms, and diagnoses as well as what to expect in treatment and recovery.

 

 

LISTEN TO THE FULL INTERVIEW HERE:

 

 

It’s a northwest lifestyle weekend on KOMO News, IRG’s Health Talk continues.

First Guest Today, Dr. Thomas Chi for Proliance Orthopedics and Sports Medicine. This guy knows what he’s talking about. Attended Harvard Medical School Board, certified Orthopedic Surgeon, a fellow for the American Academy of Orthopedic Surgeons; specializing in fracture care, foot and ankle surgery. Here to talk about the Jones fracture. What’s that in a nutshell?

Yeah. Jones fracture is the fifth metatarsal fracture. It’s fairly common but somewhat complex in its treatment and approach to treatment.

All right, let’s hear more from Dr. Thomas Chi.

Shannon O’Kelley: Dr. Chi, welcome to Health Talk. How are you today?

Dr. Chi: I’m doing great. Thanks for having me.

Shannon O’Kelley: Well, thanks for joining us. I’m excited to talk to you. We’re going to talk Jones fracture, but before we get there, you’re an orthopedic surgeon, interest in foot and ankle, done some fellowships. Tell our listeners about your practice. We were talking off the air here, you’ve got a fascinating background.

Dr. Chi: So I’m an orthopedic surgeon at Proliance Orthopaedics & Sports Medicine. We have offices in Bellevue, Issaquah, and Redmond. We have 17 orthopedic surgeons, all specialists, all fellowship trained. We all have special interests, so when you come to our practice you tend to see someone who is very, very skilled at what problem you have.

Shannon O’Kelley: And you have a fellowship, you spent some time overseas, you’ve probably seen a lot of variety of orthopedic injuries.

Dr. Chi: That’s correct. I’m fully trained in orthopedics school. I am technically allowed to do everything and after my initial training I went to Kenya and did everything for a while. I did two fellowships, one at a sports medicine place in Alabama and one at Harborview Medical Center.

Shannon O’Kelley: Well, the place that you did a fellowship in Alabama, let’s just be real. That was with doctor Jimmy Andrews, and he’s famous for all the athletes and high-level athletes that he may have seen.

Dr. Chi: That’s correct. It’s Dr. Andrews’ outfit. I’ve trained under one of his colleagues named John Gould, who unfortunately passed away a couple of years ago.

Shannon O’Kelley: Okay. Let’s talk about the foot. Let’s talk about the foot and ankle. Let’s set it up. Let’s do a little Anatomy 101 here. I always like to do Anatomy 101, it brings me back to my junior year in college. It makes me feel young, anatomy. Tell us about the foot and ankle, from an anatomical standpoint, complex.

Dr. Chi: The foot is complex, very much like the hand. There are about 26 bones, but there are many, many variations. The foot, in fact, used to be a hand. If you look at a gorilla, they have a thumb on their hand and they don’t really walk heel to toe. We’re the only creatures that truly walk heel to toe, and so the foot has changed very dramatically over its evolution.

Shannon O’Kelley: And those 26 bones, they have ligaments, they have connective tissue, there are nerves, there are vessels. I mean you described it beautifully. It’s like walking on your hands, you really are. You don’t appreciate the foot until you hurt it.

Dr. Chi: That’s correct.

Shannon O’Kelley: So those bones, I mean the blood flow and everything you have to deal with when you get into the foot and ankle. Let’s talk about a Jones fracture. We hear it sometimes, we see in the papers with athletes or people that may have Jones fracture. What is a Jones fracture?

Dr. Chi:  So the hindfoot is where your ankle and the heel part is. The midfoot is we arch is, and the forefoot is really where the middle of your foot goes to the toes. The exact middle of your foot is, Eh, is the junction between the midfoot and the forefoot. The metatarsal bones are the long bones of your arch. The Jones fracture is a fracture of the fifth metatarsal, but it’s a very special fracture because it’s a fracture that generally doesn’t heal very well. That’s why it’s one of the very feared fractures in athletes.

Shannon O’Kelley: A Jones fracture, when you describe from an anatomical standpoint, you’re basically fracturing the long bones. You called them the metatarsals, that’s the long bones. How are they important in the mechanics of the foot?

Dr. Chi: They’re really the lever on, when you go to the ball of your foot, you’re levering off kind of like a diving board, your metatarsal bones. The fifth metatarsal, the bone on the pinkie side of your toe, that’s the fifth metatarsal, really helps with stability. It’s not as a power a bone of your foot, but it helps with stability. And if you break that stabilizing force in the Jones fracture area, it tends not to heal that well.

Shannon O’Kelley: Jones fracture probably got his name from someone who discovered it. I would imagine Dr. Jones, is that probably where it came from?

Dr. Chi: That’s correct. Dr. Jones described this in himself. He was a ballroom dancer, so it was originally described as the dancer’s fracture, 1902. He X-rayed it, he figured out why it didn’t heal. It has to do, of course with blood supply. Then, ever afterward it’s been called the Jones fracture.

Shannon O’Kelley: Tell us how one would sustain a Jones fracture. What is the normal scenario?

Dr. Chi: The Jones fracture is typically caused by a sudden twisting moment. Usually, if it’s your right foot, you’re cutting to the left, and you’re pushing off of the side of your right foot. It’s usually an acute type of fracture, somewhat different than a fifth metatarsal shaft stress fracture. Although the two are very much usually grouped together. Many times people will call a fifth metatarsal stress fracture, a Jones fracture. If you read Dr. Jones original article, that’s not what he was describing. But, they behave very similarly, we treat them very similarly.

Shannon O’Kelley: Dr. Chi, again, thank you for joining us, and thank you for the great information regarding a Jones fracture. Now let’s just review. Jones fracture’s the fifth kind of pinky metatarsal in the foot, it’s sustained, or the mechanism injury is usually a plant and twist. How would I know I have a Jones fracture?

Dr. Chi:  Most people when they get a Jones fracture have very acute pain, and to have a lot of difficulties pushing off. Dr. Jones described the symptoms very well in his original article. Basically, if you push your foot off to the outside, on your pinky toe side of the ball of your foot, you can’t bear weight that way. So many people are walking on their heel, they’re hopping. It’s very difficult to walk in an acute Jones fracture.

Shannon O’Kelley: I mean, do most people know? Is this like a sudden thing, or could this be an insidious or a gradual onset?

Dr. Chi: So a true Jones fracture is actually an acute fracture. Like I said before, it behaves very similarly to a fifth metatarsal shaft stress fracture that completes itself. Regardless, once a stress fracture completes itself, there is an acute bump in pain. People know what happened.

Shannon O’Kelley: How do you diagnose it?

Dr. Chi: Almost exclusively with X-ray. There are other fractures that behave very similarly. And without an X-ray, it’s very difficult to tell the difference.

Shannon O’Kelley: So is a Jones fracture, usually what we would call midshaft fracture?

Dr. Chi: The Jones fracture, to be technical is a metadiaphyseal fracture, right? Really at the [inaudible 00:06:48] in the very base and the shaft of the fracture. Dr. Jones described it as three quarters of an inch from the base of the bone, which is about where they really happen. The fifth metatarsal avulsion fracture, it’s usually with an ankle sprain type of mechanism, is really right at the tip of the base of the bone.

Shannon O’Kelley: So now it’s diagnosed. I mean with the blood supply, or lack of blood supply would technically cause slow healing or potential lack of healing. As a physician, how do you treat this?

Dr. Chi: There are operative and nonoperative treatment options, and both are quite viable. I would say in my practice about half choose operative and about half truth non-operative, it really is a patient’s choice. The downside of treating it non-operatively is sometimes you have to go through the whole nonoperative treatment. It doesn’t heal and you have to have surgery later, and you’re out for a much longer time.

Now in an athlete, sometimes they can’t afford the time off, and so they will just elect to do the surgery right away. Most of the other patients will generally choose nonoperative treatment. The ones, of course, that heal, and two-thirds of them will heal, will be happy. And of course, the one third that doesn’t heal are not so happy.

Shannon O’Kelley: So, depending on your activity level. You mentioned athletes, I mean if they want to return quickly, this is a surgical option. The other option is kind of conservative. You probably put them in a boot for what, six to eight weeks?

Dr. Chi: Yes. At least six weeks typically. And we follow with X-rays. These always heal slowly. There was a study looking at how often these are what we call delayed unions. They actually heal, but they delay, they take a long time, more than eight weeks to heal; 66% will take more than eight weeks to heal. That’s not typical of most fractures.

Shannon O’Kelley: Is this common in … I’m thinking athletics, I’m thinking about like a lineman and people that plant and cut off that-

Dr. Chi:  Absolutely.

Shannon O’Kelley: Is that a common fracture?

Dr. Chi: Absolutely. It’s a common fracture in pivot-twisting sports, and especially heavily loaded pivot twisting sports such as football.

Shannon O’Kelley: Do you see it in any kind of age range more specifically?

Dr. Chi: This is an adult fracture. You don’t see it in the pediatric group.

Shannon O’Kelley: Adult fracture. As we close here, I mean, great information. If you want to prevent this, I mean, just strength, conditioning and flexibility? Just the usual stuff?

Dr. Chi:  That is correct.

Shannon O’Kelley: Thank you for your time, Dr. Chi.

Dr. Chi: Thanks. Glad to be here.

Speaker 2: We’ve been talking with Dr. Thomas Chi about Jones fracture, fifth metatarsal.

Shannon O’Kelley: It’s the pinky of your foot, basically. Yeah, outside. The interesting thing, there’s a lot of weight bearing and rotation on that when you’re mobile, right?

Speaker 2: Yeah. That’s good information from him. And once again, you can go to www.P-O-S-M.com. That’s Proliance Orthopaedics & Sports Medicine. Dr. Chi is one of a wonderful stable of docs at Proliance. We want to thank him for spending time with us today.

 

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