SLR - May 2020 - Claire Yearian

Pathoanatomy of the Jones Fracture in Male University Soccer Players

Reference: Fujitaka RPT PhD, Kohei, Tanaka MD PhD, Yasuhito, Taniguchi MD PhD, Akira, Ogawa MD PhD, Munehiro, Isomoto MD PhD, Shinji, Otuki MD PhD, Shingo, Okubo MD PhD, Mamoru. Pathoanatomy of the Jones Fracture in Male University Soccer Players. The American Journal of Sports Medicine. 2020 Feb; 48(2):424-431.

Scientific Literature Review

Reviewed By: Claire Yearian, DPM
Residency Program: Franciscan Health System-St. Francis Hospital – Federal Way, WA 

Podiatric Relevance: It is not uncommon to have patients, especially athletes, suffer from a Jones fracture. Unfortunately, many times these fractures have extended recovery with higher incidence of delayed union, non-union or refracture. Due to the nature of Jones fractures, it is important to identify risks factors for this injury. Previous studies have looked at the fourth-fifth intermetatarsal angle’s role in Jones fracture. This study aims to determine if fifth metatarsal length and position in relation to tarsal bones increases risk of Jones fracture. 

Methods:
Weightbearing dorsoplantar and lateral radiographs were assessed using a verified mapping system. Sixty feet from 60 male university soccer players without Jones fractures and 60 feet of 30 male university soccer players with Jones fractures were compared. Data points such as player height, weight, duration and rate of competitive soccer play, type and number of cleats, and playing surface were also considered. All players sustaining a Jones fracture had weight bearing measurements after surgical fixation. The length of fifth metatarsal and position of tarsal and metatarsal bones were measured using the verified mapping system and compared between groups. 

Results: Jones fracture groups showed a significantly longer fifth metatarsal and a more proximal fifth metatarsal tip in comparison to the control group. In addition, lateral radiograph mapping showed significantly increased medial longitudinal arch height in the Jones fracture group. 

Conclusions: This study shows that fifth metatarsal length, proximity to tarsal bones and medial longitudinal arch height have an effect on risk of Jones fracture, in addition to the previously known increased risks such as hindfoot varus, metatarsus adductus, and increased fourth-fifth intermetatarsal angle. A longer fifth metatarsal increases the stress on the proximal metatarsal due to a longer level arm.  Higher longitudinal medial arch, seen in cavus type feet, increases lateral pressure due to anatomic characteristics, but also secondary to decreased shock absorption due to supinatory foot type. The evaluation of patient’s foot type and radiographs can assist in identifying those at high risk for Jones fracture and the potential use of orthotic modifications, such as lateral heel wedge or forefoot posts, in the prevention or treatment this patient population. 

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