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Physical Therapy after a Jones Fracture

By

Updated April 24, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

A Jones fracture is a break in the fifth metatarsal, a bone of your foot that connects your pinky toe to the rest of your foot. Fractures here are a painful experience and can limit your ability to walk normally and engage in work, recreation and athletic activity.

What Causes a Jones Fracture?

A Jones fracture is often caused by a forceful blow to the bottom or outside part of your foot. Usually it occurs after jumping up and landing forcefully on your foot. Sometimes, the simple act of running can cause micro trauma to the fifth metatarsal, and a Jones fracture may occur. The onset of your pain may be gradual and happen over a period of weeks or months. When this happens, it is usually considered a stress fracture, and the prognosis for this type of Jones fracture is poorer than with an acute Jones fracture.

What are the Signs and Symptoms of a Jones Fracture?

The typical signs and symptoms of a Jones fracture include, but are not limited to:

  • Pain on the outside part of your foot
  • Swelling on the outside part of your foot
  • Discoloration or bruising on your foot
  • Difficulty walking or bearing weight on your foot

If you have injured your foot or if you have developed these symptoms, it is important that you visit your doctor or emergency department immediately. Failure to get proper treatment for your foot can cause permanent loss of function.

Initial Management of a Jones Fracture

After reporting to your doctor or the hospital and if a Jones fracture is suspected, an x-ray will most likely be taken to see the bones of your foot. The x-ray picture will show the fracture is present (or not) and proper treatment can be administered. If a Jones fracture is confirmed, the fracture must be reduced, which is the process where the bones are put in the correct place. Many times with a Jones fracture, the pieces of bone are close together, but with severe fractures, a surgical procedure called an open reduction internal fixation (ORIF) may need to be done to reduce the bones.

After reduction, your doctor will probably put your foot in a cast to help immobilize the fracture while it heals. Usually you will be be non-weight bearing, which means that you cannot put your foot on the floor and bear weight on it. Therefore, you will most likely need an assistive device, such as crutches or a walker, to walk. A visit to a physical therapist may be in order to help learn how to properly use your assistive device.

What to Expect from Physical Therapy

After an appropriate amount of healing has occurred, usually 6-8 weeks after injury, your doctor will take the cast off your foot. Don't be surprised if your foot is still swollen and discolored. This is common after a Jones fracture. Also, the muscles in your leg may appear smaller than on your non-injured leg. At this time, your doctor may refer you to physical therapy to help with your rehabilitation process.

The main focus of physical therapy after a Jones fracture is to overcome the effects of being immobilized and to improve function related to walking and moving around. Physical therapy can also help put proper stress on your healing bone. This is important, because Wolff's law states that bone heals and grows in response to the stress and strain that is placed upon it.

Physical therapy usually begins with an initial evaluation where your physical therapist will collect information about your injury. Common impairments measured and treated after a Jones fracture include:

  • Range of motion. Range of motion refers to the amount of mobility around a specific joint or joints. After a Jones fracture and wearing a cast on your foot and ankle, your ankle and foot joints may have become tight. Muscles around your ankle, foot, and toes may also have become tight, so flexibility and range of motion exercises may be necessary to help improve your mobility.

  • Swelling. When your doctor removes your cast, you may have some swelling around your foot and ankle. Your physical therapist may prescribe exercises to help with swelling. He or she may also use physical agents like heat or ice, or physical modalities like electrical stimulation may be used to help manage swelling.

  • Scar assessment (if you have had an ORIF). If you have had surgery to reduce your Jones fracture, you will have a surgical scar on the outside part of your foot. Sometimes, scar tissue forms there and prevents the skin and underlying tissue from moving normally. Scar tissue massage may be prescribed to help improve the mobility of your scar.

  • Pain. Even after a period of immobilization, there still may be pain in your foot and ankle after a Jones fracture. As you use your foot more and start putting more and more weight on it, some of the muscles and joints in the foot may become sore. There may also be some pain where the fracture was. Your physical therapist may use heat, ice, or TENS to help control your pain.

  • Strength. When you are immobilized in the cast, your muscles are not being used and therefore may become weak. Your physical therapist can help you improve the strength in the muscles around your foot and ankle. As you heal, other exercises to improve balance and plyometric exercises may be necessary to ensure that you are able to stand, walk and run normally.

  • Gait. Gait refers to the way people walk, and after a Jones fracture, your gait may not be normal. Your physical therapist can help you improve your gait by prescribing exercises and by engaging in specific activities to help improve the way you walk. He or she can also make recommendations as to which assistive device would be best for you to use.

After a few weeks of physical therapy, your pain level should be at a minimum and your strength and range of motion in your foot and ankle should be normal. Your physical therapist will progress your program at a pace that is suitable for you to ensure that you return to your previous level of function quickly. Your Jones fracture should be completely healed approximately three months after injury, depending on the severity of the fracture.

A Jones fracture can be a painful injury and can limit your ability to move around normally. Physical therapy can help ensure that you are able to quickly and safely return to normal activity and function after a Jones fracture.

Source:

Wheeless' Textbook of Orthopedics.

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